Prevalence of and risk factors for postoperative pulmonary complications after lung cancer surgery in patients with early-stage COPD

Abstract

Purpose

This study aimed to investigate whether the prevalence of postoperative pulmonary complications (PPCs) in patients with non-small-cell lung cancer (NSCLC) is even higher in the early stages of COPD than in such patients with normal lung function and to verify the usefulness of symptom- or quality of life (QoL)-based scores in predicting risk for PPCs.

Patients and methods

Patients undergoing pulmonary resection for NSCLC between July 2012 and October 2014 were prospectively enrolled. Preoperative measurements of lung function, dyspnea, and QoL, operative characteristics, PPCs, duration of postoperative hospitalization, and in-hospital mortality were assessed.

Results

Among 351 consecutive patients with NSCLC, 343 patients with forced expiratory volume in 1 second (FEV₁) ≥70% of predicted value were enrolled. At least one PPC occurred in 57 (16.6%) patients. Prevalence of PPC was higher in patients with COPD (30.1%) than in those with normal spirometry (10.0%; P<0.001). However, in patients with COPD, the prevalence of PPC was not different in patients with FEV₁ ≥70% compared to those with FEV₁ <70% and between group A (low risk and less symptoms) and group B (low risk and more symptoms) patients with COPD, based on the new Global initiative for chronic Obstructive Lung Disease 2011 guidelines. In patients with COPD, body mass index (odds ratio [OR]: 0.80, P=0.007), carbon monoxide diffusing capacity of the lung (DL_CO), % predicted value (OR: 0.97, P=0.024), and operation time (OR: 1.01, P=0.003), but not COPD assessment test or St George Respiratory Questionnaire scores, were significantly associated with PPCs.

Conclusion

Even in patients with early-stage COPD, the prevalence of PPCs is higher than in patients with NSCLC with normal spirometry. However, this rate is not different between group A and group B patients with COPD. In accordance with this, scores based on symptoms or QoL are not predictors of risk of PPCs in patients with early-stage COPD.

Keywords:

• early COPD
• postoperative pulmonary complication
• prevalence
• risk factor

Supplementary material

Table S1 Perioperative variables significantly associated with PPCs on univariate analysis

Acknowledgments

The authors acknowledge the patients with NSCLC who allowed us to conduct clinical research studies in an effort to improve the lives of patients undergoing lung cancer surgery.

Author contributions

Conception and design: ESK, C-GY, YTK, CHK, IKP; analysis and interpretation of the data: ESK, C-HL, C-GY; drafting of the article: ESK, C-GY; critical revision of the article for important intellectual content: ESK, C-HL, C-GY, YWK, SKH; final approval of the article: ESK, YTK, CHK, IKP, WB, SMC, JL, YSP, C-HL, S-ML, J-JY, YWK, SKH, C-GY. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.