Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Sci Rep. 2021 Apr 16;11(1):8359. doi: 10.1038/s41598-021-86791-1.
Chronic obstructive pulmonary disease (COPD), an established risk factor for lung cancer, remains largely undiagnosed and untreated before lung cancer surgery. We evaluated the effect of perioperative bronchodilator therapy on lung function changes in COPD patients who underwent surgery for non-small cell lung cancer (NSCLC). From a database including NSCLC patients undergoing lung resection, COPD patients were identified and divided into two groups based on the use of bronchodilator during the pre- and post-operative period. Changes in forced expiratory volume in 1 s (FEV) and postoperative complications were compared between patients treated with and without bronchodilators. Among 268 COPD patients, 112 (41.8%) received perioperative bronchodilator, and 75% (84/112) were newly diagnosed with COPD before surgery. Declines in FEV after surgery were alleviated by perioperative bronchodilator even after adjustments for related confounding factors including surgical extent, surgical approach and preoperative FEV (adjusted mean difference in FEV decline [95% CI] between perioperative bronchodilator group and no perioperative bronchodilator group; - 161.1 mL [- 240.2, - 82.0], - 179.2 mL [- 252.1, - 106.3], - 128.8 mL [- 193.2, - 64.4] at 1, 4, and 12 months after surgery, respectively). Prevalence of postoperative complications was similar between two groups. Perioperative bronchodilator therapy was effective to preserve lung function, after surgery for NSCLC in COPD patients. An active diagnosis and treatment of COPD are required for surgical candidates of NSCLC.
慢性阻塞性肺疾病（COPD）是肺癌的一个既定危险因素，在肺癌手术前，它在很大程度上未被诊断和治疗。我们评估了围手术期支气管扩张剂治疗对非小细胞肺癌（NSCLC）手术患者 COPD 患者肺功能变化的影响。从包括 NSCLC 患者肺切除术的数据库中，确定了 COPD 患者，并根据围手术期使用支气管扩张剂将其分为两组。比较了两组患者用力呼气量 1 秒（FEV）的变化和术后并发症。在 268 例 COPD 患者中，112 例（41.8%）接受了围手术期支气管扩张剂治疗，其中 75%（84/112）在术前新诊断为 COPD。即使在调整了与手术范围、手术途径和术前 FEV 等相关混杂因素后，围手术期支气管扩张剂仍能减轻术后 FEV 的下降（FEV 下降的调整平均差异[95%CI]在围手术期支气管扩张剂组和无围手术期支气管扩张剂组之间；-161.1mL[-240.2，-82.0]、-179.2mL[-252.1，-106.3]、-128.8mL[-193.2，-64.4]，分别在术后 1、4 和 12 个月）。两组术后并发症的发生率相似。围手术期支气管扩张剂治疗对 COPD 患者 NSCLC 术后肺功能的保护是有效的。对于 NSCLC 的手术候选者，需要积极诊断和治疗 COPD。
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