Author of

• 12495

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  P3.07 - Poster Session 3 - Surgery (ID 193)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12520

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    P3.07-025 - Preoperative physiologic assessment of lung cancer surgery using the modified ACCP guidelines (ID 2115)

    09:30 - 09:30  |  Author(s): T. Nakagawa
    • Abstract

    Background
    The American College of Chest Physicians(ACCP) has published the revised guidelines on preoperative physiologic assessment of lung cancer surgery. However, the relevance of the guidelines has not yet evaluated enough, partially because cardiopulmonary exercise testing recommended for achieving to the patients with poor predicted postoperative lung function is available in only limited institutions.

    Methods
    Initial analysis was conducted to examine the relationship between the maximum oxygen consumption (VdotO2 max) measured from cycling ergometer and the minimum saturation level (SpO2min) or maximum desaturation level (ΔSpO2) during 6 minute walking test (6MWT). In the next analysis, we modified the risk assessment flow chart in ACCP guidelines using SpO2min and ΔSpO2 instead of VdotO2 max. The patients with lung cancer who underwent lobectomy or more resection were retrospectively assessed using the modified flow chart.

    Results
    Using the data obtained from 39 patients with cardiac diseases and five healthy volunteers, we analyzed the correlation between VdotO2 max and variables of 6MWT. VdotO2max was significantly correlated to SpO2min and ΔSpO2 (r=0.469,p=0.001 and r=-0.458, p=0.002,respectively). Receiver operating characteristic (ROC) analysis revealed that both SpO2min and ΔSpO2 was available for the detection of the patients with VdotO2max of <15 mL/kg/min which is the borderline value between the average and increased risk group in ACCP guidelines (AUC 0.802, p=0.001 and AUC 0.802, p=0.001, respectively). When the cut-off value was set as SpO2min <91%, sensitivity and specificity was 85.2％ and 70.6％,respectively. When the cut-off value was set as ΔSpO2>4%, sensitivity and specificity was 74.1％and 76.5％,respectively. We introduced a new decision criteria of SpO2min <91% or ΔSpO2>4% instead of VdotO2max of <15 mL/kg/min in the final step of the flow chart in ACCP guidelines. A total of 965 patients were evaluated according to the modified flow chart and 883 (91.5%) patients were classified to the average risk group and 31 (3.2%) patients were classified to the increased risk group. Fifty-one (5.3%) patients were excluded because of the lack of 6MWT data. In regard to surgical outcome, there was a significant difference between the average risk group and the increased risk group in introduction rate of home oxygen therapy (0.7% vs. 25.8%,p<0.001) and cardiopulmonary oriented 90-day mortality rate (0.8% vs. 9.7%,p<0.001).

    Conclusion
    Figure 1In the clinical practice, the modified ACCP risk flow chart may be easier to apply and useful for the perioperative risk assessment of the patients with lung cancer being considered for standard resection.