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Ann Thorac Surg 2000;70:1161-1167
© 2000 The Society of Thoracic Surgeons

Original articles: general thoracic

Identification of prognostic factors determining risk groups for lung resection

Alain Bernard, MDa, Loic Ferrand, MDa, Olivier Hagry, MDa, Laurent Benoit, MDa, Nicolas Cheynel, MDa, Jean-Pierre Favre, MDa

a Department of Thoracic Surgery, France

Address reprint requests to Dr Bernard, Hôpital Universitaire, 2 bd Marechal de Lattre de Tassigny, BP 1542, 21034 Dijon CEDEX, France
e-mail: alain.bernard{at}chu-dijon.fr

Background. Pulmonary resection belongs to a group of surgical procedures with significant morbidity and mortality. The aims of this study were to classify postoperative complications and to identify prognostic factors determining risk group.

Methods. In a prospective study 500 patients undergoing lung resection (wedge resection, n = 141; lobectomies, n = 245; bilobectomies, n = 12; and pneumonectomies, n = 102) were included. In 178 patients (36%) pulmonary resections were extended to structures or thoracic organs. Sleeve resection of the bronchus to preserve lung parenchyma was performed in 22 patients.

Results. Classification of postoperative complications fell into four categories: patients without postoperative complications; patients with moderate complications (n = 137); patients with severe complications (n = 38); and death (n = 33). Factors adversely affecting postoperative complications by multivariate analysis included pulmonary pathology, bronchoplastic technique, forced expiratory volume in 1 second (FEV1), extended resection, type of lung resection, comorbidity indices, and preoperative chemotherapy. Four risk groups were determined. Risk group I (n = 60) with the best prognosis included patients with FEV1 greater than or equal to 80% undergoing wedge resection for a benign lesion or metastasis. Risk group II (n = 161) included patients with FEV1 greater than or equal to 80% undergoing major pulmonary resection for a benign lesion or metastasis or lung cancer, or patients with FEV1 less than 80% undergoing wedge resection for benign lesion or metastasis. Risk group III (n = 233) with a fair prognosis included patients with comorbidity indices less than 4 and FEV1 greater than or equal to 80% undergoing extended pulmonary resection for a benign lesion or metastasis or lung cancer, or patients with FEV1 less than 80% and emphysema. Risk group IV (n = 46) with the worst prognosis included patients with FEV1 less than 80% undergoing an extended lung resection or bronchoplastic procedures for a benign lesion or metastasis or lung cancer, or patients with comorbidity indices greater than or equal to 4 undergoing extended lung resection for lung cancer.

Conclusions. In a prospective study, based on these prognostic factors, a practical, easy-to-use risk group system of lung resection is proposed as a tool to aid the decision to perform lung resection.




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