Pneumonectomy may be safe for patients with destroyed lung (DL), including those with preoperative forced expiratory volume in 1 second (FEV1) values of 2 L or less, according to a study in BMC Pulmonary Medicine.
Under current guidelines, it is recommended that patients undergoing pneumonectomy have a preoperative FEV1 of greater than 2 L. Investigators assessed long-term prognosis and safety of pneumonectomy in patients with destroyed lung, comparing outcomes for those with FEV1 of 2 L or less vs FEV1 of greater than 2 L.
The retrospective study assessed data from 123 patients who underwent pneumonectomy at a hospital in Beijing, China, from November 2002 to February 2023. Outcomes assessed included postoperative 30-day mortality, incidence of postoperative complications, long-term mortality, residual lung reinfection, tuberculosis (TB) recurrence, bronchial stump fistula/empyema, the proportion of patients with modified Medical Research Council (mMRC) scores of at least 1 at follow-up, and postoperative rehospitalization rate. Follow-up interviews were administered through June 30, 2023.
Of the entire study cohort, 96.7% were discharged without postoperative complications.
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The preoperative lung function criterion FEV1 >2 L may not be an appropriate indication for pneumonectomy in DL patients.
To further analyze outcomes, researchers divided study participants into 2 groups: the higher FEV1 group (FEV1 >2 L), which included 30 (24.4%) participants (18 men; overall mean [SD] age, 44.6 [12.3] years); and the lower FEV1 group (FEV1 ≤2 L), which included 93 (75.6%) patients (69 women; overall mean age, 40.2 [13.7] years).
The higher FEV1 group had a higher proportion of men and people who smoked compared with the lower FEV1 group (P =.001 and P =.027, respectively). The higher FEV1 group also had a significantly increased mean forced vital capacity (FVC) as a percentage of predicted values compared with the lower FEV1 group (65.1 [14.4] vs 57.2 [1.6], respectively, P =.003). The higher FEV1 group also had a higher proportion of patients with detectable pulmonary cavities on chest computed tomography (CT) scans than the lower FEV1 group (46.7% vs 24.7%, respectively, P =.023)
No significant intergroup differences were observed in mortality rate within 30 days after surgery/discharge or the postoperative complication rate in a comparison of short-term surgical outcomes. In addition, regarding long-term outcomes through the end of follow-up, no significant intergroup differences occurred in rates of mortality, residual lung reinfection/TB recurrence, bronchial stump fistula/empyema, mMRC score, and rehospitalization.
In logistic regression analysis, no significant differences in correlations were observed between independent and dependent variables for the higher FEV1 and lower FEV1 groups. Independent variables included FEV1 as a continuous variable and the covariates sex, age, smoking, and lesions on chest CT images. Dependent variables included mortality rates within 30 days postsurgery and postoperative complication rates and long-term outcomes such as mortality rates, residual lung reinfection/TB recurrence, bronchial stump fistula/empyema, postoperative hospitalization, and the proportion of patients with mMRC of at least 1 during follow-up.
Study imitations include the retrospective design and a relatively small number of cases from a single center. Also, 21.7% of patients were lost to follow-up, and variations in expertise in the thoracic surgeons and diverse surgical techniques may have introduced biases.
“The preoperative lung function criterion FEV1 >2 L may not be an appropriate indication for pneumonectomy in DL patients, particularly in the absence of surgical guidelines or consensus,” the study authors stated. “Given the current lack of compelling evidence, further research is warranted to ascertain the true predictive value of FEV1 in assessing postoperative risks of DL patients.”
