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Ann Thorac Surg 2006;81:1830-1837
© 2006 The Society of Thoracic Surgeons

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Original article: General thoracic

Operative Mortality and Respiratory Complications After Lung Resection for Cancer: Impact of Chronic Obstructive Pulmonary Disease and Time Trends

^a Departments of Anesthesiology, Pharmacology, and Surgical Intensive Care, University Hospital of Geneva, Geneva
^b Department of Thoracic Surgery, University Hospital of Geneva, Geneva
^c Chest Medical Center, Montana, Switzerland

Accepted for publication November 28, 2005.

^_* Address correspondence to Dr Licker, Service d'Anesthésiologie, Hopital Universitaire, rue Micheli-Ducrest, CH-1211, Genève 14, Switzerland (Email: marc-joseph.licker{at}hcuge.ch).

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 FEV₁less 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.

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