Operative mortality and respiratory complications after lung resection for cancer: Impact of chronic obstructive pulmonary disease and time trends - Invited commentary
Operative mortality and respiratory complications after lung resection for cancer: Impact of chronic obstructive pulmonary disease and time trends - Invited commentary
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DOI：
10.1016/j.athoracsur.2005.11.048
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发表时间：
2006-05-01
影响因子：
4.6
通讯作者：
Rocco, G
中科院分区：
文献类型：
--
作者：
Licker, MJ;Widikker, I;Rocco, G
背景。吸烟是慢性阻塞性肺疾病（COPD）、心血管疾病和肺癌的常见危险因素。在这项观察性研究中，我们研究了COPD严重程度和时间相关变化对肺癌切除术后早期预后的影响。在15年的时间里，我们分析了一个机构登记，包括所有连续接受肺癌手术的患者。采用受试者工作特征（ROC）曲线，分析1秒用力呼气量（FEV1）与术后死亡率和呼吸系统发病率的关系。多元回归分析也被用于识别其他危险因素。术前FEV1小于60%是呼吸系统并发症（优势比[OR] = 2.7，可信区间[CI]: 1.3至6.6）和30天死亡率（OR = 1.9, CI: 1.2至3.9）的有力预测因子，而胸段硬膜外镇痛与较低的死亡率（OR = 0.4, CI: 0.2至0.8）和呼吸系统并发症（OR = 0.6, CI: 0.3至0.9）相关。死亡率还与年龄大于70岁、存在至少三种心血管危险因素和全肺切除术有关。从1990年到1994年，到2000年到2004年，我们观察到围手术期死亡率（3.7%对2.4%）和呼吸系统并发症发生率（18.7%对15.2%）的显著降低，这与较小切除率的提高（从11%到17%，p < 0.05）和胸段硬膜外镇痛的增加（从65%到88%，p < 0.05）有关。术前FEV1小于60%是围手术期死亡率和呼吸系统发病率的主要预测指标。在过去的5年里，早期病理性癌症阶段的诊断导致较少的肺切除以及提供持续的胸廓硬膜外镇痛有助于改善手术结果。
Background. Smoking is a common risk factor for chronic obstructive pulmonary disease ( COPD), cardiovascular disease, and lung cancer. In this observational study, we examined the impact of COPD severity and time-related changes in early outcome after lung cancer resection.Methods. Over a 15-year period, we analyzed an institutional registry including all consecutive patients undergoing surgery for lung cancer. Using the receiver-operating characteristic (ROC) curve, we analyzed the relationship between forced expiratory volume in 1 second (FEV1) and postoperative mortality and respiratory morbidity. Multiple regression analysis has also been applied to identify other risk factors.Results. A preoperative FEV1 less than 60% was a strong predictor for respiratory complications (odds ratio [OR] = 2.7, confidence interval [CI]: 1.3 to 6.6) and 30-day mortality (OR = 1.9, CI: 1.2 to 3.9), whereas thoracic epidural analgesia was associated with lower mortality (OR = 0.4; CI: 0.2 to 0.8) and respiratory complications (OR = 0.6; CI: 0.3 to 0.9). Mortality was also related to age greater than 70 years, the presence of at least three cardiovascular risk factors, and pneumonectomy. From the period 1990 to 1994, to 2000 to 2004, we observed significant reductions in perioperative mortality (3.7% versus 2.4%) and in the incidence of respiratory complications (18.7% versus 15.2%,) that was associated with a higher rate of lesser resection (from 11% to 17%, p < 0.05) and increasing use of thoracic epidural analgesia (from 65% to 88%, p < 0.05).Conclusions. Preoperative FEV1 less than 60% is a main predictor of perioperative mortality and respiratory morbidity. Over the last 5-year period, diagnosis of earlier pathologic cancer stages resulting in lesser pulmonary resection as well as provision of continuous thoracic epidural analgesia have contributed to improved surgical outcome.