Summary at a glance
Introduction
Materials and methods
Study population
Preoperative evaluation
CT findings
Postoperative pulmonary complications
Statistical analysis
Results
Patients and tumor characteristics
All (n = 488) | No PPCs (n = 436) | PPCs (n = 52) | p-value | |
---|---|---|---|---|
Age, yr | 73 (71–76) | 73 (71–75) | 73 (71–76) | 0.427 |
Sex, male | 233 (47.7) | 198 (45.4) | 35 (67.3) |
0.003
|
BMI (kg/m2) | 24.1 (22.1–25.9) | 24.2 (22.2–26.1) | 23.3 (20.7–25.1) |
0.007
|
Smoking status |
0.013
| |||
Current smoker | 160 (32.8) | 134 (30.8) | 26 (50.0) | |
Former smoker | 51 (10.5) | 45 (10.3) | 6 (11.5) | |
Never smoker | 276 (56.6) | 256 (58.9) | 20 (38.5) | |
ASA classification |
0.021
| |||
1 | 32 (6.6) | 31 (7.1) | 1 (1.9) | |
2 | 433 (88.7) | 388 (89.0) | 45 (86.5) | |
≥ 3 | 23 (4.7) | 17 (3.9) | 6 (11.5) | |
Comorbidity | ||||
Diabetes mellitus | 105 (21.5) | 95 (21.8) | 10 (19.2) | 0.806 |
Hypertension | 257 (52.7) | 230 (52.8) | 27 (51.9) | 0.999 |
Congestive heart failure | 3 (0.6) | 3 (0.7) | 0 | 0.999 |
Ischemic heart disease | 37 (7.6) | 33 (7.6) | 4 (7.7) | 0.999 |
Atrial fibrillation | 21 (4.3) | 19 (4.4) | 2 (3.8) | 0.999 |
Previous cancer history | 86 (17.6) | 72 (16.5) | 14 (26.9) | 0.095 |
Double primary cancer | 42 (8.6) | 37 (8.5) | 5 (9.6) | 0.990 |
Laboratory finding | ||||
Serum hemoglobin (g/dL) | 13.0 (12.3–14.0) | 13.6 (12.6–14.5) | 12.5 (11.6–14.3) | 0.065 |
Serum albumin (g/dL) | 4.3 (4.1–4.5) | 4.3 (4.0–4.5) | 4.2 (4.0–4.4) | 0.614 |
Pulmonary function test | ||||
FVC (% pred) | 92 (85–100) | 90 (84–98) | 89 (83–96) | 0.061 |
FEV1 (% pred) | 101 (93–110) | 100 (92–109) | 99 (91–109) | 0.579 |
FEV1/FVC | 76 (73–79) | 75 (72–77) | 76 (72–78) | 0.430 |
DLCO (% pred) (N = 388) | 111 (104–118) | 111 (104–119) | 108 (107–113) | 0.869 |
CT finding | ||||
Interstitial lung abnormality (%) | 1.38 (4.14) | 1.19 (3.57) | 2.92 (7.22) |
0.004
|
Emphysema index (%) | 2.49 (7.61) | 2.16 (6.97) | 5.21 (11.4) |
0.006
|
Superimposed infection | 42 (8.6) | 38 (8.7) | 4 (7.7) | 0.999 |
Mosaic attenuation | 95 (19.5) | 87 (20.0) | 8 (15.4) | 0.548 |
Bronchial wall thickening | 15 (3.1) | 14 (3.2) | 1 (1.9) | 0.933 |
Bronchiectasis | 111 (22.7) | 101 (23.2) | 10 (19.2) | 0.642 |
Diameter of MPA | 28.0 (3.64) | 28.0 (3.66) | 27.8 (3.51) | 0.637 |
Diameter of AA | 39.0 (4.08) | 39.1 (4.14) | 38.1 (3.45) | 0.092 |
Diameter of MPA to AA > 1 | 3 (0.6) | 3 (0.7) | 0 | 0.999 |
All (n = 488) | No PPCs (n = 436) | PPCs (n = 52) | p-value | |
---|---|---|---|---|
Tumor histology |
0.003
| |||
Adenocarcinoma | 381 (78.1) | 350 (80.3) | 31 (59.6) | |
Squamous cell carcinoma | 81 (16.6) | 65 (14.9) | 16 (30.8) | |
Other NSCLCs | 26 (5.3) | 21 (4.8) | 5 (9.6) | |
Tumor location | 0.186 | |||
Right upper lobe | 164 (33.6) | 147 (33.7) | 17 (32.7) | |
Right middle lobe | 34 (7.0) | 31 (7.1) | 3 (5.8) | |
Right lower lobe | 99 (20.3) | 82 (18.8) | 17 (32.7) | |
Left upper lobe | 108 (22.1) | 100 (22.9) | 8 (15.4) | |
Left lower lobe | 83 (17.0) | 76 (17.4) | 7 (13.5) | |
Tumor staging | ||||
T stage | 0.296 | |||
cT1a | 120 (24.6) | 109 (25.0) | 11 (21.2) | |
cT1b | 136 (27.9) | 125 (28.7) | 11 (21.2) | |
cT2a | 163 (33.4) | 145 (33.3) | 18 (34.6) | |
cT2b | 39 (8.0) | 33 (7.6) | 6 (11.5) | |
cT3 | 30 (6.1) | 24 (5.5) | 6 (11.5) | |
N stage | 0.833 | |||
cN0 | 458 (93.9) | 409(93.8) | 49 (94.2) | |
cN1 | 30 (6.1) | 26(6.2) | 3 (5.8) | |
Extent of surgery |
0.005
| |||
Pneumonectomy & Bilobectomy | 18 (3.7) | 12 (2.8) | 6 (11.5) | |
Lobectomy | 370 (75.8) | 332 (76.1) | 38 (73.1) | |
Segmentectomy & Wedge resection | 100 (20.5) | 92 (21.1) | 8 (15.4) | |
VATS | 353 (72.3) | 321 (73.6) | 32 (61.5) | 0.093 |
MLND (%) | 0.992 | |||
None | 30 (6.1) | 27 (6.2) | 3 (5.8) | |
Selective | 38 (7.8) | 34 (7.8) | 4 (7.7) | |
Systematic | 420 (86.1) | 375 (86.0) | 45 (86.5) |
Development of PPCs
30-day mortality | 90-day mortality | 180-day mortality | |
---|---|---|---|
No PPC (n = 436) | 0 (0/436) | 0.23 (1/434) | 0.69 (2/431) |
PPC (n = 52) | 1.9 (1/50) | 5.77 (2/48) | 7.7(1/47) |
p-value |
0.031
|
0.016
|
0.008
|
Factors associated with PPC development
Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|
Variable | OR (95% CI) | p-value | OR (95% CI) | p-value |
Age | 0.96 (0.88–1.06) | 0.427 | ||
Sex, male | 2.47 (1.35–4.55) |
0.004
| ||
Smoking history (current & former) | 2.25 (1.25–4.07) |
0.007
| ||
ASA classification ≥3 | 1.79 (1.10–2.93) |
0.019
| 1.91 (1.14–3.21) |
0.014
|
BMI | 1.15 (1.05–1.29) |
0.003
| 0.86 (0.78–0.95) |
0.004
|
Hemoglobin | 1.18 (0.95–1.46) | 0.066 | ||
Squamous vs. others | 2.54 (1.33–4.84) |
0.005
| ||
ILA | 1.07 (1.02–1.12) |
0.009
| 1.91 (1.02–1.13) |
0.004
|
Emphysema index | 1.04 (1.01–1.07) |
0.010
| ||
Extent of surgery | ||||
Segmentectomy & Wedge resection & Lobectomy | Reference | Reference | ||
Pneumonectomy & Bilobectomy | 4.61 (1.65–12.8) |
0.004
| 4.46 (1.54–12.9) |
0.006
|
Univariate analysis | Multivariate analysis | |||
---|---|---|---|---|
Variable | OR (95% CI) | p-value | OR (95% CI) | p-value |
Age | 1.02 (0.91–1.14) | 0.781 | ||
Sex, male | 2.29 (1.01–5.20) |
0.048
| ||
Smoking history (current & former) | 1.95 (0.89–4.29) | 0.098 | ||
ASA classification ≥3 | 1.29 (0.61–2.75) | 0.501 | ||
BMI | 0.85 (0.74–0.97) |
0.015
| 0.86 (0.74–1.01) |
0.052
|
Hemoglobin | 0.76 (0.57–1.01) |
0.066
| ||
Squamous vs. others | 1.85 (0.75–4.48) | 0.186 | ||
ILA | 1.09 (1.03–1.15) |
0.003
| 1.09 (1.03–1.16) |
0.003
|
Emphysema index | 1.03 (0.99–1.07) | 0.067 | ||
Extent of surgery | ||||
Segmentectomy & Wedge resection & Lobectomy | Reference | Reference | ||
Pneumonectomy & Bilobectomy | 5.55 (1.69–18.2) |
0.005
| 5.57 (1.63–19.0) |
0.006
|