Licker Marc J, Widikker Igor, Robert John, Frey Jean-George, Spiliopoulos Anastase, Ellenberger Christoph, Schweizer Alexandre, Tschopp Jean-Marie
Department of Anesthesiology, University Hospital of Geneva, Geneva, Switzerland.
Ann Thorac Surg. 2006 May;81(5):1830-7. doi: 10.1016/j.athoracsur.2005.11.048.
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.
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.
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).
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.
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严重程度以及肺癌切除术后早期结局的时间相关变化的影响。
在15年期间，我们分析了一个机构登记处的数据，该登记处包括所有连续接受肺癌手术的患者。使用受试者工作特征（ROC）曲线，我们分析了一秒用力呼气量（FEV1）与术后死亡率和呼吸并发症之间的关系。还应用了多元回归分析来确定其他危险因素。
术前FEV1低于60%是呼吸并发症（比值比[OR]=2.7，置信区间[CI]：1.3至6.6）和30天死亡率（OR=1.9，CI：1.2至3.9）的有力预测指标，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、至少存在三种心血管危险因素以及肺切除术有关。从1990年至1994年期间到2000年至2004年，我们观察到围手术期死亡率（3.7%对2.4%）和呼吸并发症发生率（18.7%对15.2%）显著降低，这与较小切除率的提高（从11%至17%，p<0.05）和胸段硬膜外镇痛使用的增加（从65%至88%，p<0.05）有关。
术前FEV1低于60%是围手术期死亡率和呼吸并发症的主要预测指标。在过去5年期间，早期病理癌症阶段的诊断导致较小的肺切除以及持续胸段硬膜外镇痛的提供有助于改善手术结局。
