Background
Rationale
Objectives
Methods
Study design and protocol
Patient selection
Outcome data, measures and definitions
Grouping criteria
Surgical procedure, perioperative care and discharge criteria
Statistical analysis
Results
Basic information and outcomes
Patient characteristics
Characteristics | Total (N = 429) | Cardiopulmonary complications | P-value | |
---|---|---|---|---|
Yes (N = 80) | No (N = 349) | |||
Basic information | ||||
Age (Years) | ||||
Mean ± SD | 62.5 ± 8.2 | 64.7 ± 7.7 | 62.0 ± 8.2 | 0.006 |
Median (IQR) | 63 (58–69) | 63 (59–72) | 62 (56–68) | |
Gender (Male gender) | 266 (62.0%) | 50 (62.5%) | 216 (61.9%) | 0.92 |
Body mass index (kg/m2) | ||||
Mean ± SD | 23.4 ± 2.9 | 23.5 ± 3.1 | 23.4 ± 2.9 | 0.80 |
Median (IQR) | 23.3 (21.3–25.5) | 23.4 (21.1–26.2) | 23.3 (21.3–25.5) | |
Smoking history | 221 (51.5%) | 45 (56.3%) | 176 (50.4%) | 0.35 |
Preoperative underlying comorbidities | ||||
Chronic obstructive pulmonary disease | 105 (24.5%) | 29 (36.3%) | 76 (21.8%) | 0.007 |
Asthma | 8 (1.9%) | 2 (2.5%) | 6 (1.7%) | 0.99 |
Tuberculosis | 35 (8.2%) | 8 (10.0%) | 27 (7.7%) | 0.51 |
Preoperative respiratory infection | 43 (10.0%) | 21 (26.3%) | 22 (6.3%) | < 0.001 |
Hypertension | 152 (35.4%) | 35 (43.8%) | 117 (33.5%) | 0.085 |
Diabetes mellitus | 46 (10.7%) | 14 (17.5%) | 32 (9.2%) | 0.030 |
Coronary heart disease | 46 (10.7%) | 13 (16.3%) | 33 (9.5%) | 0.076 |
Hyperlipidemia | 11 (2.6%) | 4 (5.0%) | 7 (2.0%) | 0.26 |
Renal insufficiency | 41 (9.6%) | 9 (11.3%) | 32 (9.2%) | 0.57 |
Severe liver diseases | 49 (11.4%) | 13 (16.3%) | 36 (10.3%) | 0.13 |
Previous malignancy | 27 (6.3%) | 3 (3.8%) | 24 (6.9%) | 0.30 |
Steroid use | 22 (5.1%) | 5 (6.3%) | 17 (4.9%) | 0.82 |
Combined treatment modalities | ||||
Neoadjuvant therapy | 33 (7.7%) | 11 (13.8%) | 22 (6.3%) | 0.024 |
Adjuvant chemotherapy | 153 (35.7%) | 26 (32.5%) | 127 (36.4%) | 0.51 |
Intraoperative parameters | ||||
Tumor location | ||||
Right upper lobe | 148 (34.5%) | 35 (43.8%) | 113 (32.4%) | 0.22 |
Left upper lobe | 72 (16.8%) | 9 (11.3%) | 63 (18.1%) | |
Right lower lobe | 93 (21.7%) | 19 (23.8%) | 74 (21.2%) | |
Left lower lobe | 64 (14.9%) | 9 (11.3%) | 55 (15.8%) | |
Right middle lobe | 52 (12.1%) | 8 (10.0%) | 44 (12.6%) | |
Presence of pleural invasion | ||||
None | 209 (48.7%) | 37 (46.3%) | 172 (49.3%) | 0.80 |
Visceral | 201 (46.9%) | 40 (50.0%) | 161 (46.1%) | |
Parietal | 19 (4.4%) | 3 (3.8%) | 16 (4.6%) | |
Severity of pleural adhesion | ||||
None | 172 (40.1%) | 30 (37.5%) | 142 (40.7%) | 0.084 |
Light | 136 (31.7%) | 23 (28.7%) | 113 (32.4%) | |
Moderate | 79 (18.4%) | 13 (16.3%) | 66 (18.9%) | |
Severe/extremely severe | 42 (9.8%) | 14 (17.5%) | 28 (8.0%) | |
Pulmonary fissure completeness | ||||
Complete | 280 (65.3%) | 41 (51.2%) | 239 (68.5%) | 0.004 |
Incomplete | 149 (34.7%) | 39 (48.8%) | 110 (31.5%) | |
Estimated intraoperative blood loss (mL) | ||||
Mean ± SD | 89.2 ± 128.6 | 133.3 ± 191.3 | 79.1 ± 107.1 | < 0.001 |
Median (IQR) | 50 (30–100) | 90 (50–110) | 50 (30–100) | |
Operation time (Min) | ||||
Mean ± SD | 131.5 ± 56.8 | 167.9 ± 72.1 | 122.6 ± 48.6 | < 0.001 |
Median (IQR) | 120 (90–160) | 150 (110–210) | 120 (90–150) | |
Amount of intraoperative fluids (mL) | ||||
Mean ± SD | 1175.1 ± 555.2 | 1272.5 ± 505.8 | 1150.9 ± 565.1 | 0.10 |
Median (IQR) | 1000 (800–1500) | 1100 (950–1550) | 1000 (800–1400) | |
Conversion to thoracotomy | 16 (3.7%) | 8 (10.0%) | 8 (2.3%) | 0.003 |
Pathological parameters | ||||
Histology | ||||
Adenocarcinoma | 315 (73.4%) | 63 (78.8%) | 252 (72.2%) | 0.24 |
Squamous cell carcinoma | 94 (21.9%) | 15 (18.8%) | 79 (22.6%) | |
Adeno-squamous carcinoma | 12 (2.8%) | 2 (2.5%) | 10 (2.9%) | |
Large cell carcinoma | 8 (1.9%) | 0 (0.0%) | 8 (2.3%) | |
Differentiation degree | ||||
Low | 83 (19.3%) | 13 (16.3%) | 70 (20.1%) | 0.44 |
Moderate/high | 346 (80.7%) | 67 (83.8%) | 279 (79.9%) | |
Tumor invasion (T-stage) | ||||
T1 | 163 (38.0%) | 31 (38.8%) | 132 (37.8%) | 0.030 |
T2 | 242 (56.4%) | 39 (48.8%) | 203 (58.2%) | |
T3 | 24 (5.6%) | 10 (12.5%) | 14 (4.0%) | |
Lymph node metastasis (N-stage) | ||||
N1–2 | 95 (22.1%) | 17 (21.3%) | 78 (22.3%) | 0.83 |
N0 | 334 (77.9%) | 63 (78.8%) | 271 (77.7%) | |
TNM-stage | ||||
I | 305 (71.1%) | 59 (73.8%) | 246 (70.5%) | 0.43 |
II | 68 (15.9%) | 9 (11.3%) | 59 (16.9%) | |
IIIa | 56 (13.1%) | 12 (15.0%) | 44 (12.6%) |
Surgical outcomes
Complications | Total (N = 429) | EIBL< 100 mL (N = 296) | EIBL≥100 mL (N = 133) | P-value |
---|---|---|---|---|
Overall morbidity | ||||
Any cardiopulmonary complication | 80 (18.6%) | 40 (13.5%) | 40 (30.1%) | < 0.001 |
Pulmonary complications | 74 (17.2%) | 35 (11.8%) | 39 (29.3%) | < 0.001 |
Cardiovascular complications | 12 (2.8%) | 5 (1.7%) | 7 (5.3%) | 0.038 |
Individual cardiopulmonary complications | ||||
Pneumonia | 49 (11.4%) | 22 (7.4%) | 27 (20.3%) | < 0.001 |
Atelectasis | 25 (5.8%) | 8 (2.7%) | 17 (12.8%) | < 0.001 |
Pleural effusion requiring chest tube drainage | 9 (2.1%) | 4 (1.4%) | 5 (3.8%) | 0.21 |
Pulmonary artery embolism | 3 (0.7%) | 1 (0.3%) | 2 (1.5%) | 0.23 |
Hemoptysis requiring pharmacological intervention | 2 (0.5%) | 2 (0.7%) | 0 (0.0%) | 1.0 |
Acute respiratory distress syndrome | 1 (0.2%) | 1 (0.3%) | 0 (0.0%) | 1.0 |
Atrial fibrillation | 4 (0.9%) | 2 (0.7%) | 2 (1.5%) | 0.59 |
Sinus irregularity requiring pharmacological intervention | 5 (1.2%) | 2 (0.7%) | 3 (2.3%) | 0.18 |
Ventricular fibrillation | 2 (0.5%) | 0 (0.0%) | 2 (1.5%) | 0.096 |
Comparisons between PCC group and non-PCC group
Preoperative variables
Intraoperative variables
Pathological variables
ROC analysis on the prediction of EIBL for PCCs
Association between threshold EIBL and development of PCCs
Overall morbidity
Individual cardiopulmonary complications
Multivariable analysis of risk factors for PCCs
Estimated factors | Odds ratio | 95% confidence interval | P-value |
---|---|---|---|
Age (≥65 vs. < 65 years) | 1.18 | 0.60–2.33 | 0.62 |
Chronic obstructive pulmonary disease | 1.51 | 0.73–3.12 | 0.27 |
Preoperative respiratory infection | 4.55 | 1.89–10.93 | 0.001 |
Diabetes mellitus | 4.04 | 1.62–10.04 | 0.003 |
Neoadjuvant therapy | 2.50 | 0.78–7.99 | 0.12 |
Estimated intraoperative blood loss (≥100 vs. < 100 mL) | 3.01 | 1.47–6.16 | 0.003 |
Operation time (≥120 vs. < 120 min) | 2.38 | 1.16–4.89 | 0.018 |
Pulmonary fissure completeness (Incomplete vs. Complete) | 1.19 | 0.61–2.33 | 0.61 |
Conversion to thoracotomy | 1.26 | 0.36–4.35 | 0.72 |
T-stage (T2–3 vs. T1) | 1.74 | 0.91–3.31 | 0.093 |