Outcomes of lobectomy in patients with severely compromised lung function (predicted postoperative diffusing capacity of the lung for carbon monoxide % < 40%)

Rationale: Patients defined as high operative risk by pulmonary function tests are often denied lobectomy or offered potentially less curative options, including sublobar resection or stereotactic body radiation therapy. Objectives: The aim of this study was to determine the outcomes of lobectomy in a group of patients deemed high risk based on predicted postoperative diffusing capacity of carbon monoxide (DLCO) less than or equal to 40%. Methods: This is a retrospective review of a prospectively collected database of patients who underwent lobectomy with a predicted postoperative DLCO% less than or equal to 40%. Survival was calculated using the Kaplan-Meier method, and multivariate predictors were determined using regression analysis. Measurements andMain Results: Lobectomy was performed in 50 patients with a predicted DLCO less than or equal to 40% (median predicted postoperative DLCO%, 35%). The median age was 71 years, 68% (n = 34) were women, and 84% (n = 42) had an Eastern Cooperative Oncology Group performance status of 0. Eight patients had both predicted postoperative FEV1% or predicted postoperative DLCO% less than or equal to 40%. Thoracoscopic lobectomy was performed in 36% (n = 18) and reoperations in 6% (n = 3). There was no operative mortality. Seventy percent (n = 35) of patients had no complications, with a median length of stay of 5 days. The most frequent complications were pulmonary (14% [n = 7]) and cardiovascular (12% [n = 6]). Four patients (8%) were discharged on home oxygen, and four (8%) required rehabilitation post discharge. Multivariable analyses evaluating the effects of age, sex, comorbidities, smoking status, and operative approach on all-cause morbidity, postoperative home oxygen use, and a composite of the two were performed. Diabetes was found to be a predictor of the composite of all-cause morbidity and postoperative home oxygen use. Overall 5-year survival for the entire cohort was 69% (95% confidence interval, 52-87%). Conclusions: Lobectomy can be safely performed in select patients considered to be high risk for resection by pulmonary function tests. Additional criteria are needed to assess risk.