Changing in Paradigm: thoracoscopic anatomical lung resection with VO2max under 10 ml/kg/min is still possible

Résumé fourni par la source

Background: Patients with average and severe respiratory insufficiency, i.e. FEV1 under 1,5L and postoperative predicted value under 800 ml (30%) and DLCO under 60% and postoperative predicted value under 30% are recommended for Spiroergometry to asses risk for anatomical lung resections. Maximal oxygen consumption (VO2max) under 15 ml/kg/min is a strong indication for high perioperative risk. Furthermore VO2max under 10 indicates a very high mortality and an anatomical lung resection are not recommended. Material and method: We did a retrospective Study in our lung cancer department to analyse the VO2max influence on the overall postoperative mortality. We analysed patient's data of 364 video-assisted thoracoscopic (VATS) anatomical resection between 2009 and 2018. Altogether 292 VATS lobectomies and 72 VATS anatomical segment resections were performed. We recorded and analysed patients demographic data, medical history, lung function and maximal oxygen uptake. Average and duration of surgery, all postoperative morbidity and mortality cases were recorded and analysed. We used software package SPSS Statistic to determine interconnection between perioperative patients investigations data and postoperative outcome. Result: The average patients age was 60 (+/-9) years. The lowest VO2max was 8 ml/kg/min and highest 29 ml/kg/min, average 16.45 ml/kg/min. By comparing of the lobectomy group and anatomical segment resection group we found no statistical significance in overall survival between the two groups (t (0.025) for 95% CI = 1.976; p = 0.90144). By analysis in survival between VO2max under 10, and VO2 max between 11 and 15, we did not found any statistical difference between the two groups (t (0.025) for 95% CI = 2.0272; p = 0.9225). Conclusion: We can conclude the with good selected patients in an experienced lung cancer centre a video- assisted thoracoscopic anatomical lung resection with VO2max under 10 ml/kg/min is still possible.

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