PREOPERATIVE PULMONARY FUNCTION AS A PREDICTOR OF RESPIRATORY COMPLICATIONS AND MORTALITY IN PATIENTS UNDERGOING LUNG CANCER RESECTION
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概要
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Objective: We evaluated preoperative pulmonary function as a predictor of respiratory complications and mortality in patients undergoing lung cancer resection to confirm the guideline of the British Thoracic Society : lung cancer surgery in patients with predictive postoperative FEV1.0 (%FEV1.0ppo)>40% and predictive postoperative diffusion capacity for carbon monoxide (%DLCOppo)>40% can be carried out with average risk.Methods: We retrospectively studied 356 consecutive patients who underwent pulmonary resection at our Department from January 1992 to December 2001. Preoperative pulmonary function tests included vital capacity (VC), %VC, forced expiratory volume in one second (FEV1.0), FEV1.0%, diffusion capacity for carbon monoxide (DLCO), predictive postoperative FEV1.0 (FEV1.0 ppo), postoperative respiratory function expressed as a percentage of the predicted normal value (%FEV1.0ppo, %DLCOppo). Postoperative complications were divided into 2 groups: respiratory complications (pneumonia, atelectasis, etc) and other complications (bronchopleural fistu la, prolonged air leak, arrhythmia, etc).Results: Postoperative deaths occurred in 14 (3.9%) patients. Postoperative respiratory complications developed in 27 (7.6%) patients. Pneumonectomy (p<0.001), preoperative chemotherapy (p<0.01) and advanced stage (p<0.05) were identified as risk factors of postoperative deaths.Patients undergoing lobectomy with FEV1.0≥1,500 ml did not die of respiratory complications. Patients undergoing pneumonectomy with FEV1.0ppo≥800 ml/m2 did not die of respiratory complications. Patients undergoing pneumonectomy with %FEV1.0ppo<40% and %DLCOppo<40% did not survive. Five of the 7 patients who died of respiratory complications were treated with preoperative chemotherapy. The values of their %DLCOppo were all less than 40%. By multivariate analysis, %FEV1.0ppo was significant independent factor associated postoperative death.Conclusions: We conclude that the guideline is useful for the selection for surgery of lung cancer patients. If preoperative chemotherapy is performed, the measurement of %DLCO is recommended before surgery.
- 福島医学会の論文
著者
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Ohsugi Jun
Department of Surgery 1, Fukushima Medical University
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Higuchi Mitsunori
Department of Surgery 1, Fukushima Medical University
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Shio Yutaka
Department of Surgery 1, Fukushima Medical University
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Fujiu Koichi
Department Of General Thoracic Surgery Southern Tohoku General Hospital
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Oishi Akio
Department Of Ophthalmology And Visual Sciences Kyoto University Graduate School Of Medicine
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Kanno Ryuzo
Department Of Thoracic Surgery Iwaki Kyoritsu General Hospital
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Gotoh Mitsukazu
Department Of Organ Regenerative Surgery Fukushima Medical University
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Suzuki Hiroyuki
Department Of Animal Science Faculty Of Agriculture Hokkaido University
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HIGUCHI MITSUNORI
Department of Surgery I, Fukushima Medical University School of Medicine
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KANNO RYUZO
Department of Surgery I, Fukushima Medical University School of Medicine
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SHIO YUTAKA
Department of Surgery I, Fukushima Medical University School of Medicine
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