Extending Surgical Indication For Minimally Invasive Thoracic Surgery For Patients With Marginal Lung Function
Hiroko NAKAHAMA, Kostantinos Poulikidis, James Lubawski, William Adams, Heli Kapadia, Wickii Vigneswaran.
Loyola University Medical Center, Maywood, IL, USA.
BackgroundThe predicted post-operative forced expiratory volume after 1 second (FEV1) and the diffusing capacity of lung for carbon monoxide (DLCO) are used to predict post-operative respiratory complications and survival. Despite the benefits of minimally invasive surgery in patients with marginal lung function, current practice guidelines advocate non-surgical approach for treatment based on evidence derived from patients undergoing thoracotomy. It is necessary to define what should be minimum acceptable lung function for resection in the era of minimally invasive surgery. MethodsRetrospective review of all patients with pre-operative marginal lung function of FEV1 or DLCO <60% that underwent minimally invasive lung resection with robotic or laparoscopic-assisted techniques. Patient demographics and clinical data were collected and the 30-day morbidity and mortality were assessed with propensity matched control groups whose predicted functions were above 60%. Pre-operative predicted DLCO and FEV1 were compared using paired t-tests, using McNemar’s exact tests. Separate analysis using unmatched groups were performed to compare patients with FEV1 or DLCO less than 40%, 41-50%, and 51-60% using Fisher exact tests. Results283 patients who underwent lung resection between January 2017 to May 2019 were retrospectively reviewed. There were no differences in post-operative outcomes between cases with marginal lung function and paired controls with normal lung function (p > .05). Among those in the FEV1 or DLCO < 40% cohort, more patients required a post-operative chest tube for pneumothorax (22%) compared to those in the FEV1 or DLCO > 60% cohort (2.6%), FEV1 or DLCO 51-60% cohort (2.6%), and FEV1 or DLCO 41-50% cohort (0%). ConclusionPre-operative FEV1 and DLCO less than 60% resulted in no significant difference in morbidity or mortality. Post-operative pneumothorax requiring chest tube was noted to be higher in patients with values <40% predicted lung function. Therefore lung resection should not be withheld to patients with pre-operative marginal lung functions when minimally invasive techniques are utilized.
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