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Ann Thorac Surg 1985;39:260-265
© 1985 The Society of Thoracic Surgeons

Articles

A Method for Predicting Postoperative Lung Function and Its Relation to Postoperative Complications in Patients with Lung Cancer

Kazuya Nakahara, M.D.*, Yasumasa Monden, M.D., Kiyoshi Ohno, M.D., Shinichiro Miyoshi, M.D., Hajime Maeda, M.D., Yasunaru Kawashima, M.D.

From the First Department of Surgery, Osaka University Medical School, Osaka, Japan

Accepted for publication May 10, 1984.

* Address reprint requests to Dr. Nakahara, First Department of Surgery, Osaka University Medical School, 1-1-50, Fukushima-Ku, 553, Osaka, Japan

We predicted the postoperative forced expiratory volume in 1 second (FEV1) with a formula based on the premise that the total number of subsegments was 42: postop FEV1 = [1 – (b – n)/(42 – n)] (preop FEV1), where n and b are the number of obstructed subsegments and total subsegments, respectively, in the resected lobe. It was assumed that b was 6, 4, and 12 in the right upper, middle, and lower lobes, respectively, and 10 each in the left upper and the left lower lobes. The obstructed subsegments, n, were obtained from the findings on bronchography or bronchofiberscopy or both before operation. The linear regression line derived from the correlation between predicted (x) and measured (y) FEV1 was y = 0.850x + 0.286 ± 0.296 (standard error) (N = 52; r = 0.821; p < 0.001).

We calculated the predicted postoperative FEV1 in 188 patients with primary lung cancer. The predicted values were corrected with the regression equation just mentioned and then normalized by the patient's height and sex (%FEV1(p,c)). The correlation between %FEV1(p,c) and the surgical risk was studied. Postoperative respiratory complications were inversely related to %FEV1(p,c), and a significantly high incidence of complications (p < 0.05) was observed in those whose %FEV1(p,c) was less than 60% of predicted normal. In aged patients (65 years old or more) without complications, %FEV1(p,c) was 67.3 ± 18.0%; it was 52.2 ± 12.8% in those with respiratory trouble and 53.3% ± 9.6% in those with circulatory complications. The difference between groups with and without complications was significant (p < 0.01). In the nonaged group, there were no significant differences among the patients with no complications, respiratory complications, or circulatory complications.

We conclude that our formula involving subsegments is a reliable method for predicting postoperative lung function and is a predictor of the surgical risk in aged patients with lung cancer.




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