Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK.
Eur J Cardiothorac Surg. 2024 Mar 1;65(3). doi: 10.1093/ejcts/ezad337.
Ventilatory efficiency [minute ventilation-to-carbon dioxide output slope (VE/VCO2 slope)] can be measured at sub-maximal workload during cardiopulmonary exercise test. The aim of this study is to assess the association between VE/VCO2 slope and outcome after lung cancer resections.
Retrospective, single-centre analysis on all patients undergoing lung resection for cancer (April 2014-August 2022) and with a preoperative cardiopulmonary exercise test. VE/VCO2 slope >40 was chosen as high-risk threshold. Logistic regression analysis was used to test the association of VE/VCO2 slope and several patient- and surgery-related factors with 90-day mortality.
A total of 552 patients were included (374 lobectomies, 81 segmentectomies, 55 pneumonectomies and 42 wedge resections). Seventy-four percent were minimally invasive procedures. Cardiopulmonary morbidity was 32%, in-hospital/30-day mortality 6.9% and 90-day mortality 8.9%. A total of 137 patients (25%) had a slope of >40. These patients were older (72 vs 70 years, P = 0.012), had more frequently coronary artery disease (17% vs 10%, P = 0.028), lower carbon monoxide lung diffusion capacity (57% vs 68%, P < 0.001), lower body mass index (25.4 vs 27.0 kg/m2, P = 0.001) and lower peak VO2 (14.9 vs 17.0 ml/kg/min, P < 0.001) than those with a lower slope. The cardiopulmonary morbidity among patients with a slope of >40 was 40% vs 29% in those with lower slope (P = 0.019). Ninety-day mortality was 15% vs 6.7% (P = 0.002). The 90-day mortality of elderly patients with slope >40 was 21% vs 7.8% (P = 0.001). After adjusting for peak VO2 value, extent of operation and other patient-related variables in a logistic regression analysis, VE/VCO2 slope retained a significant association with 90-day mortality.
VE/VCO2 slope was strongly associated with morbidity and mortality following lung resection and should be included in the functional algorithm to assess fitness for surgery.
在心肺运动试验中，可以在亚最大工作负荷下测量通气效率[分钟通气量与二氧化碳输出斜率（VE/VCO2 斜率）]。本研究的目的是评估 VE/VCO2 斜率与肺癌切除术后结局的关系。
回顾性分析 2014 年 4 月至 2022 年 8 月期间所有接受肺癌切除术（肺叶切除术 374 例，肺段切除术 81 例，全肺切除术 55 例，楔形切除术 42 例）并进行术前心肺运动试验的患者。选择 VE/VCO2 斜率>40 作为高危阈值。使用逻辑回归分析来测试 VE/VCO2 斜率与几个与患者和手术相关的因素与 90 天死亡率之间的关联。
共纳入 552 例患者（肺叶切除术 74%为微创手术）。552 例患者中，74%为微创手术。心肺发病率为 32%，住院/30 天死亡率为 6.9%，90 天死亡率为 8.9%。共有 137 例（25%）患者的斜率>40。这些患者年龄更大（72 岁与 70 岁，P=0.012），更常患有冠状动脉疾病（17%与 10%，P=0.028），一氧化碳肺扩散能力更低（57%与 68%，P<0.001），体重指数更低（25.4 与 27.0kg/m2，P=0.001），峰值 VO2 更低（14.9 与 17.0ml/kg/min，P<0.001）。VE/VCO2 斜率>40 的患者的心肺发病率为 40%，而斜率<40 的患者为 29%（P=0.019）。90 天死亡率为 15%与 6.7%（P=0.002）。VE/VCO2 斜率>40 的老年患者 90 天死亡率为 21%，而斜率<40 的老年患者为 7.8%（P=0.001）。在逻辑回归分析中，调整峰值 VO2 值、手术范围和其他与患者相关的变量后，VE/VCO2 斜率与 90 天死亡率仍有显著相关性。
VE/VCO2 斜率与肺切除术后的发病率和死亡率密切相关，应纳入评估手术适应性的功能算法中。
