Degiovanni Sara, Parini Sara, Baietto Guido, Massera Fabio, Papalia Esther, Bora Giulia, Ferrante Daniela, Balbo Piero Emilio, Rena Ottavio
Division of Thoracic Surgery, Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy.
Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.
J Thorac Dis. 2024 Dec 31;16(12):8184-8191. doi: 10.21037/jtd-24-447. Epub 2024 Dec 27.
Pulmonary function assessment is mandatory before oncological lung resection surgery. To do so, subjects undergo a pulmonary function test (PFT) and the calculation of predicted postoperative (PPO) values to estimate the residual lung function after surgery. The aim of this study is to evaluate the use of anatomical formulae in estimating postoperative pulmonary function in patients undergoing minimally invasive surgery (MIS).
This is a retrospective study. Patients affected by lung cancer who underwent pulmonary lobectomy or segmentectomy with MIS or thoracotomy approach at our center from June 2020 to May 2021 were considered. Exclusion criteria were: subjects who underwent atypical pulmonary resection surgery or pneumonectomy; and patients who underwent adjuvant therapy (chemotherapy or immunotherapy). PFT data measured before and 1 year after surgery were collected. In particular, postoperative PFT data, especially forced expiratory volume in the first second (FEV1) and diffusing capacity for carbon monoxide (DLCO), and PPO values calculated by the anatomical formulae were compared. Secondary endpoints were: analysis of the postoperative pulmonary function in patients who underwent lung resection with the standard approach (thoracotomy) and evaluation of the anatomical formulae accuracy in subjects operated through thoracotomy.
The sample consisted of 48 patients operated on MIS (video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery) and 20 subjects who underwent thoracotomy for stage I-IIA and I-IIB lung cancer in both groups. The anatomical formula seemed to underestimate the postoperative FEV1% by 8.65% [interquartile range (IQR), 0.5-17.28%; P<0.001]. Furthermore, when comparing postoperative PPO and post-operative DLCO%, a significant difference was shown with an underestimation of the actual postoperative value of 2.78% (IQR, -3.63% to 10.47%; P=0.045).
Our results confirmed that the anatomical formulae currently used to predict postoperative pulmonary function are reliable in the case of the standard approach (thoracotomy), while they tend to overestimate the loss of FEV1 and DLCO in the postoperative period in patients who were operated on MIS, thus excluding some subjects from the operation.
在进行肿瘤性肺切除手术前，必须进行肺功能评估。为此，受试者要接受肺功能测试（PFT）并计算术后预测（PPO）值，以估计手术后的残余肺功能。本研究的目的是评估解剖学公式在评估接受微创手术（MIS）患者术后肺功能中的应用。
这是一项回顾性研究。纳入了2020年6月至2021年5月在本中心接受MIS或开胸手术进行肺叶切除术或肺段切除术的肺癌患者。排除标准为：接受非典型肺切除术或全肺切除术的受试者；以及接受辅助治疗（化疗或免疫治疗）的患者。收集手术前和术后1年测量的PFT数据。特别比较了术后PFT数据，尤其是第一秒用力呼气量（FEV1）和一氧化碳弥散量（DLCO），以及通过解剖学公式计算的PPO值。次要终点为：分析采用标准方法（开胸手术）进行肺切除的患者的术后肺功能，以及评估通过开胸手术的受试者中解剖学公式的准确性。
样本包括48例接受MIS手术（电视辅助胸腔镜手术和机器人辅助胸腔镜手术）的患者以及两组中因I-IIA期和I-IIB期肺癌接受开胸手术的20例受试者。解剖学公式似乎将术后FEV1%低估了8.65%[四分位间距（IQR），0.5-17.28%；P<0.001]。此外，比较术后PPO和术后DLCO%时，显示出显著差异，实际术后值被低估了2.78%（IQR，-3.63%至10.47%；P=0.045）。
我们的结果证实，目前用于预测术后肺功能的解剖学公式在标准方法（开胸手术）的情况下是可靠的，而在接受MIS手术的患者中，它们往往高估了术后FEV1和DLCO的损失，从而将一些受试者排除在手术之外。
