Ann Thorac Surg. 2020 Sep 28:S0003-4975(20)31536-8. doi: 10.1016/j.athoracsur.2020.07.035. Online ahead of print.
BACKGROUND: Postoperative severe respiratory adverse events (SRAEs) are the major cause of perioperative morbidity in patients after thoracic surgery. In particular, SRAEs often occur in lung cancer patients concomitant with chronic inflammatory lung diseases (CILDs) such as interstitial lung disease, emphysema, infectious disease, and asthma. We aimed to clarify whether the measurement of the maximum of standardized uptake value in the noncancerous lung area (NCA-SUVmax) and CILDs on high-resolution computed tomography were useful for predicting the risk of SRAEs.
METHODS: A total of 984 patients with lung cancer undergoing preoperative computed tomography, F-18 fluorodeoxyglucose-positron emission tomography/ computed tomography followed by surgery between July 2012 and March 2019 were assessed. NCA-SUVmax was measured using a three-dimensional workstation. We extracted patients with CILDs and their disease history. Predictive factors associated with SRAEs were identified.
RESULTS: SRAEs were observed in 75 patients (7.6%), while 7 patients (9.3%) died of SRAEs within 90 days after surgery. NCA-SUVmax in patients with CILDs (n = 325; emphysema = 161, interstitial lung disease = 134, infectious disease = 17, asthma = 13) were higher than that in patients without CILDs (n = 659; 1.3+0.7 vs. 1.1+0.4, respectively; p <.001). On multivariate analysis, CILDs, %vital capacity and NCA-SUVmax were independently associated with SRAEs (p <.001). Rate of SRAEs in patients with CILDs, NCA-SUVmax > 1.3, and %vital capacity ≤ 110 was 31.8%.
CONCLUSIONS: NCA-SUVmax was independently associated with the incidence of SRAEs in patients resected lung cancer and was significantly increased in patients with CILDs.