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~ng cancer is the most common cause of cancer associated with atherosclerotic vascular disease, mak-
death in the United States. 1 An estimated 168,000 ing these conditions prevalent in patients with lung
new cases will occur this year, 2 and the majority will carcinoma. Thus, the clinician is often faced with the
die within the first year after diagnosis.3 For patients problem of considering lung resection as the only
with non-small-cell carcinoma presenting as localized curative treatment in a patient with significant comorbid
disease and ventilatory impairment.
For editorial comment see page 654 A wide range of tests has been evaluated to aid the
identification of patients at high risk for developing
disease, surgical resection remains the only potentially complications after lung resection. These tests have
curative option 4 The high rate of coexistent medical included spirometry, arterial blood gas measurement
conditions in lung cancer patients complicates referral (ABC), exercise testing, and radionuclide lung scan-
of such patients to surgery. Smoking is highly associ- ning. Previously reported studies have sought to de-
ated with the development of lung carcinoma;5 the fine values for each of these modalities that would
incidence increases further in smokers with COPD.B-9 identify patients at prohibitive risk. 10- 15 Demographic
Additionally, smoking and chronic lung disease are variables such as male sex, advanced age, and smoking
status have been shown to identify groups at increased
*From the Respiratory Division( Dr. Reilly) , Division of Tho-
racic Surgery (Drs. DeCamp and Sugarbaker), Department of risk. 6 814161i Reported complication rates after lung
Medicine (Dr. Lee) , Brigham & Women's Hospital, and De- resection have ranged from a 40 percent rate of death
partme nt of Medicine (Dr. Kearney) , Beth Israel Hospital ,
Boston. or severe disability in the 1950s and 1960s to mortality
Manuscript received March 24, 1993; revision accepted July 23. rates of9 to 27 percent in the 1970s} 2 18' 20 Advances in
Reprint requests: Dr. Srfgarbaker, Division of Thoracic Surgenj,
Briglwmand Wom en's Hospital, Boston 02115. operative technique and postoperative care have led
%
1-
i 10
0~
0
2 3
An y Cardiac Respiratory
TYPE OF COMPLICATION
FI<: l! HE I. Postoperati\e complication rate according to predicted postope ratiq FE\' ntlue.
1
had a postoperative complication vs 8 (9 percent) of 88 had a significantly lower rate of any complication.
patients without any history (p < 0.05). Eight (6 percent) of 12i patients having a wedge
Patients with a preoperative FEV 1 of less than 1 L resection had a complication vs 48 (24 percent) of
did not have an increased overall complication rate. 204 patients having a more extensive procedure
Complications occurred in 3 (18 percent) of li (p < 0.001). Patients who underwent lobectomies or
patients with a FEV 1 less than 1 L vs .51 ( 1i percent) four or more wedge resections did not have signifi-
of 30i patients with a preoperative FEV 1 greater cantly different complication rates when compared
than 1 L (p value not significant). Complication with patients not having these procedures.
rates also were evaluated according to preoperative
Pco., data on ABC analysis. No significant differ- Complication Rate by Predicted Postoperative
ence in the overall complication rate was noted for FEV 1 Values
patients with a Pco 2 greater than or equal to 4.5 mm Figure 1 shows the postoperative complication
Hg preoperatively. Four ( 13 percent) of 30 patients rate stratified according to predicted postoperative
with hypercarbia had complications vs 50 (li per- FEV 1 value. Complication rates were assessed for
cent) of 285 patients without hypercarbia (p value other complications , cardiac complications, and res-
not significant). Preoperative exercise pulse oximetry piratory complications . Forty-seven patients had a
data also was assessed (as evaluated by recording predicted postoperative FEV 1 less than 1 L, and 16
the lowest percent saturation during a 6-min walk of these (34 percent) had other complications, 9 ( 19
on a level surface followed by two flights of stairs) . percent) had a cardiac complication, and i ( 15
This was not associated with an increased occur- percent ) had a respiratory complication. Fifty-six
rence of complications. Twelve ( 16 percent) of ii patients had predicted postoperative FEV 1 of 1.01
patients with desaturation on exercise pulse oximetry to 1.40 L, and 14 (25 percent) of these had other
had complications vs 28 ( 1.5 percent) of 18.5 patients complications, 12 (21 percent) had a cardiac com-
without desaturation (p value not significant). plication, and .5 (9 percent) had a respiratory com-
Patients were classified according to the extent of plication. Two hundred twenty-one patients had a
lung resection performed, and differences in com- predicted postoperative FEV 1 of greater than 1.4 L,
plication rates were examined (Table 3). Patients and 24 ( 11 percent) of these had other complica-
undergoing a pneumonectomy had a significantly tions , 20 (9 percent) had cardiac complications, and
higher rate of complications . All deaths occurred in 6 (3 percent) had respiratory complications. As the
the group undergoing pneumonectomies. Eighteen predicted postoperative FEV 1 declined , a signifi-
(39 percent) of 46 patients undergoing a pneumon- cant association \Vas found for an increased occur-
ectomy had a complication vs 38 (13 percent) of 28.5 rence of other complications (p < 0.001), cardiac
patients not having this procedure (p < 0.001) . Pa- complications (p < 0.0.5), and respiratory complica-
tients undergoinig one to three wedge resections tions (p < 0.001) .