Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
Eur J Cardiothorac Surg. 2011 May;39(5):738-44. doi: 10.1016/j.ejcts.2010.09.007. Epub 2010 Oct 16.
Although it may seem intuitive that obesity is an additional risk factor for surgical patients, few studies have correlated this condition with lung cancer resection. The only data currently available suggest that obesity does not increase the rate of complications after anatomic resection for non-small-cell lung cancer (NSCLC).
We enrolled 154 consecutive patients undergoing standard pneumonectomy for NSCLC at the Department of Thoracic Surgery of the European Institute of Oncology from January 2004 to April 2008. To determine the influence of preoperative body mass index (BMI) on postoperative complications, patients were classified into two groups: (1) BMI ≥ 25 kg m⁻²; n = 93 (60.4%); and (2) BMI < 25 kg m⁻²; n = 61 (39.6%). Data on sex, age, cigarette smoking, preoperative albumin, total proteins and creatinine values, forced expiratory volume in 1s percentage (FEV1%), diffusion lung capacity for carbon monoxide/alveolar volume percentage (DLCO/AV%) and histology and pathological stage were collected. Information on total postoperative complications, 30-day mortality rate, specific pulmonary and cardiac complications, intensive care unit (ICU) admission and hospital stay was collected and analysed for the BMI group.
Among the 154 operated patients, 30 (19.5%) were women with a mean age of 63.4 years (range: 36-82). As many as 136 (88.3%) patients were smokers or former smokers; 80 patients (51.9%) received presurgical treatment. A total of 64 (41.6%) right pneumonectomy procedures were performed. Mean ± SD for preoperative variables were FEV1%: 83.5 ± 19.2, DLCO/AV: 85.4% ± 20.3, albumin: 4.07 ± 0.44 g dl(-1), total proteins: 7.23 ± 0.59 g dl⁻¹, creatinine: 0.81 ± 0.23 mg dl⁻¹. Ten patients died within the first 30 days (30-day mortality: 6.5%). The male sex was significantly more prevalent in the high BMI group (p=0.039). The preoperative mean creatinine value was significantly higher in the high BMI group (0.86 mg dl(-1) vs 0.75 mg dl⁻¹, p=0.002) and preoperative DLCO/AV values were better in the high BMI group than in the BMI group < 25 kg m⁻² (79.9 vs 88.8, p = 0.009). The high BMI group had a higher incidence of respiratory complications (21.5% vs 4.9% p = 0.005, odds ratio (OR) = 5.3, 95% confidence interval (CI): 1.5, 18.7). No significant differences were observed between the two groups regarding ICU admission, hospital stay, 30-day mortality and total and specific cardiac complications.
The risk of respiratory complications in patients with BMI higher than 25 kg m⁻² undergoing pneumonectomy for lung cancer is 5.3 times higher than that of patients with BMI < 25 kg m⁻². Thoracic surgeons and anaesthesiologists should be aware of this information before planning elective pneumonectomy in overweight and especially in obese patients.
尽管肥胖似乎是手术患者的另一个危险因素，但很少有研究将这种情况与肺癌切除术相关联。目前唯一可用的数据表明，肥胖并不会增加非小细胞肺癌（NSCLC）解剖性切除术的并发症发生率。
我们招募了 154 名在 2004 年 1 月至 2008 年 4 月期间在欧洲肿瘤研究所胸外科接受标准肺切除术的连续 NSCLC 患者。为了确定术前体重指数（BMI）对术后并发症的影响，将患者分为两组：（1）BMI≥25kg/m²；n=93（60.4%）；（2）BMI＜25kg/m²；n=61（39.6%）。收集了性别、年龄、吸烟状况、术前白蛋白、总蛋白和肌酐值、1 秒用力呼气量百分比（FEV1%）、一氧化碳弥散量/肺泡容积比（DLCO/AV%）以及组织学和病理分期的数据。收集并分析了 BMI 组的总术后并发症、30 天死亡率、特定的肺部和心脏并发症、重症监护病房（ICU）入住率和住院时间。
在 154 名接受手术的患者中，有 30 名（19.5%）为女性，平均年龄为 63.4 岁（范围：36-82 岁）。多达 136 名（88.3%）患者为吸烟者或曾经吸烟者；80 名患者（51.9%）接受了术前治疗。共进行了 64 例（41.6%）右肺切除术。术前变量的平均值±标准差为：FEV1%：83.5±19.2，DLCO/AV：85.4%±20.3，白蛋白：4.07±0.44g/dL，总蛋白：7.23±0.59g/dL，肌酐：0.81±0.23mg/dL。10 名患者在术后 30 天内死亡（30 天死亡率：6.5%）。高 BMI 组中男性比例明显更高（p=0.039）。高 BMI 组的术前平均肌酐值明显更高（0.86mg/dL 比 0.75mg/dL，p=0.002），高 BMI 组的术前 DLCO/AV 值优于 BMI＜25kg/m² 组（79.9 比 88.8，p=0.009）。高 BMI 组的呼吸系统并发症发生率较高（21.5%比 4.9%，p=0.005，比值比（OR）=5.3，95%置信区间（CI）：1.5，18.7）。两组之间在 ICU 入住率、住院时间、30 天死亡率以及总并发症和特定心脏并发症方面没有显著差异。
BMI 高于 25kg/m² 的患者接受肺切除术治疗肺癌时，发生呼吸系统并发症的风险是 BMI＜25kg/m² 的患者的 5.3 倍。胸外科医生和麻醉师在为超重患者，特别是肥胖患者计划选择性肺切除术之前，应了解这一信息。
