From the Departments of Anesthesiology and Pain Medicine.
Nuclear Medicine.
Clin Nucl Med. 2024 Nov 1;49(11):e574-e579. doi: 10.1097/RLU.0000000000005395. Epub 2024 Jul 15.
Lung cancer surgery outcomes depend heavily on preoperative pulmonary reserve, with forced expiratory volume in 1 second (FEV1) being a critical preoperative evaluation factor. Our study investigates the discrepancies between predicted and long-term actual postoperative lung function, focusing on clinical factors affecting these outcomes.
This retrospective observational study encompassed lung cancer patients who underwent preoperative lung perfusion SPECT/CT between 2015 and 2021. We evaluated preoperative and postoperative pulmonary function tests, considering factors such as surgery type, resected volume, and patient history including tuberculosis. Predicted postoperative lung function was calculated using SPECT/CT imaging.
From 216 patients (men:women, 150:66; age, 67.9 ± 8.7 years), predicted postoperative FEV1% (ppoFEV1%) showed significant correlation with actual postoperative FEV1% ( r = 0.667; P < 0.001). Paired t test revealed that ppoFEV1% was significantly lower compared with actual postoperative FEV1% ( P < 0.001). The study identified video-assisted thoracic surgery (VATS) (odds ratio [OR], 3.90; 95% confidence interval [CI], 1.98-7.69; P < 0.001) and higher percentage of resected volume (OR per 1% increase, 1.05; 95% CI, 1.01-1.09; P = 0.014) as significant predictors of postsurgical lung function improvement. Conversely, for the decline in lung function postsurgery, significant predictors included lower percentage of resected lung volume (OR per 1% increase, 0.92; 95% CI, 0.86-0.98; P = 0.011), higher preoperative FEV1% (OR, 1.03; 95% CI, 1.01-1.07; P = 0.009), and the presence of tuberculosis (OR, 5.19; 95% CI, 1.48-18.15; P = 0.010). Additionally, in a subgroup of patients with borderline lung function, VATS was related with improvement.
Our findings demonstrate that in more than half of the patients, actual postsurgical lung function exceeded predicted values, particularly following VATS and with higher volume of lung resection. It also identifies lower resected lung volume, higher preoperative FEV1%, and tuberculosis as factors associated with a postsurgical decline in lung function. The study underscores the need for precise preoperative lung function assessment and tailored postoperative management, with particular attention to patients with relevant clinical factors. Future research should focus on validation of clinical factors and exploring tailored approaches to lung cancer surgery and recovery.
肺癌手术的结果在很大程度上取决于术前的肺储备能力，其中 1 秒用力呼气量（FEV1）是术前评估的关键因素。本研究旨在探讨预测与长期实际术后肺功能之间的差异，并重点关注影响这些结果的临床因素。
这是一项回顾性观察研究，纳入了 2015 年至 2021 年间接受术前肺灌注 SPECT/CT 检查的肺癌患者。我们评估了术前和术后的肺功能检查，考虑了手术类型、切除体积以及包括结核病在内的患者病史等因素。使用 SPECT/CT 成像计算预测术后的肺功能。
在 216 名患者（男：女，150：66；年龄，67.9±8.7 岁）中，预测术后 FEV1%（ppoFEV1%）与实际术后 FEV1%呈显著相关性（r=0.667；P<0.001）。配对 t 检验显示，ppoFEV1%明显低于实际术后 FEV1%（P<0.001）。研究发现，电视辅助胸腔镜手术（VATS）（比值比[OR]，3.90；95%置信区间[CI]，1.98-7.69；P<0.001）和更高的切除体积百分比（每增加 1%的切除体积，OR 为 1.05；95%CI，1.01-1.09；P=0.014）是术后肺功能改善的显著预测因素。相反，对于术后肺功能下降，显著的预测因素包括切除肺体积百分比降低（每增加 1%的切除体积，OR 为 0.92；95%CI，0.86-0.98；P=0.011）、术前 FEV1%较高（OR，1.03；95%CI，1.01-1.07；P=0.009）和结核病（OR，5.19；95%CI，1.48-18.15；P=0.010）。此外，在肺功能处于边缘状态的患者亚组中，VATS 与肺功能改善相关。
我们的研究结果表明，在超过一半的患者中，实际术后肺功能超过了预测值，尤其是在接受 VATS 治疗和切除更多肺组织后。研究还发现，切除的肺体积较低、术前 FEV1%较高以及结核病是与术后肺功能下降相关的因素。该研究强调了术前肺功能评估的精确性以及术后管理的重要性，特别是对存在相关临床因素的患者。未来的研究应关注临床因素的验证，并探索针对肺癌手术和康复的个体化方法。
