Pik Oksijen Tüketimi Ölçümünün Erken Evre Akciğer Kanserli Hastalarda Postoperatif Komplikasyonları Öngörmedeki Değeri

Abstract

The best survival rates of lung cancer patients are seen in those who underwent resection. Detailed preoperative pulmonary evaluation of such patients is of critical value in order not to deprive a patient from a potentially curative surgery. Cardiopulmonary Exercise Testing (CPET) is an important preoperative study because of its ability to detect disturbance in oxygen transport system which inturn is related to development of postoperative complications. The aim of this study is to identify the value of peak oxygen consumption (peak VO2) measurement in predicting early postoperative complications in early stage lung cancer patients.

All the patients who were diagnosed as lung cancer and candidates for surgey in the Departments of Chest Surgery and Chest Diseases between February 2015 and February 2017 were included in this propectively conducted study. CPET were performed. Peak VO2 measurement was performed to these patients by utilizing cycle ergometry and the current system (Fitmate®Med) during incremental exercise. All patients were on follow-up for postoperative complications (prolonged mechanical ventilation (>48 hrs), hypoxemia, respiratory failure, pneumonia, empyema, atelectasis, ARDS, pulmonary edema) for a period of 30 days.

The mean age of 41 patients was 63.9±9.7 years. 28 patients underwent lobectomy, 13 pneumonectomy. PeakVO2 value was higher than 15 ml/kg/min in all of the patients. While there wasn’t any mortality, there were postoperative pulmonary complications in 8 patients (19.5%). Those were prolonged mechanical ventilation in 7 patients and empyema in 1 patient. Postoperative pulmonary complication rates were not different between lobectomies and pneumonectomies. The mean age of patients was similar in those patients with and without postoperative complications. When the patients were divided into two groups based on preoperative absolute values of FEV1 (≤1.5 L and >1.5 L) and ppoFEV1% (≤%30 and >%30), mean peakVO2 values, mean staying days in intensive care and hospital, postoperative pulmonary complication ratios were similar between groups. 14 patients who had a FEV1 ≤1,5 L and 11 patients who had a ppoFEV1 ≤%30 underwent successful surgical resections.

In conclusion; peak VO2 measurement with CPET prevents patients to be deprived of a surgical resection that is an important treatment modality of lung cancer. Postoperative complications were in acceptable levels in patients with adequate peak VO2 values.