Prediction of pulmonary complications after a lobectomy in patients with non-small cell lung cancer

Background-Although the preoperative prediction of pulmonary complications after lung major surgery has been reported in various papers, it still remains unclear. Methods-Eighty nine patients with stage I-IIIA non-small cell lung cancer (NSCLC) who underwent a complete resection at our institute from 1994-8 were evaluated for the feasibility of making a preoperative prediction of pulmonary complications. All had either a predicted postoperative forced vital capacity (FVC) of >800 ml/m(2) or forced expiratory volume in one second (FEV1) of >600 ml/m(2). Results-Postoperative complications occurred in 37 patients (41.2%) but no patients died during the 30 day period after the operation. Pulmonary complications occurred in 20 patients (22.5%). Univariate analysis indicated that the factors significantly related to pulmonary complications were FVC <80%, serum lactate dehydrogenase (LDH) level <greater than or equal to>230 U/1, and arterial oxygen tension (Pao(2)) <10.6 kPa (80 mm Hg). In a multivariate analysis the three independent predictors of pulmonary complications were serum LDH <greater than or equal to>230 U/1 (odds ratio (OR) 10.5, 95% CI 1.4 to 77.3), residual volume (RV)/total lung capacity (TLC) greater than or equal to 30% (OR 6.0, 95% CI 1.1 to 33.7), and Pao(2) <10.6 kPa (OR 5.6, 95% CI 1.4 to 22.2). Conclusions-The above findings indicate that three factors (serum LDH levels of <greater than or equal to>230 U/1, RV/TLC greater than or equal to 30%, and Pao(2) <10.6 kPa) may be associated with pulmonary complications in patients undergoing a lobectomy for NSCLC, even though the patient group was relatively small for statistical analysis of such a diverse subject as pulmonary complications.