Early outcomes of "low-risk" patients undergoing lung resection assessed by cardiopulmonary exercise testing: Single-institution experience

Riccardo Orlandi; Rocco Francesco Rinaldo; Alessandra Mazzucco; Andrea Baccelli; Michele Mondoni; Francesca Marchetti; Mariapia Zagaria; Jacopo Cefalo; Andrea Leporati; Matteo Montoli; Giorgio Ghilardi; Alessandro Baisi; Stefano Centanni

doi:10.3389/fsurg.2023.1130919

Early outcomes of "low-risk" patients undergoing lung resection assessed by cardiopulmonary exercise testing: Single-institution experience

Front Surg. 2023 Mar 16:10:1130919. doi: 10.3389/fsurg.2023.1130919. eCollection 2023.

Affiliations

¹ Department of Thoracic Surgery, University of Milan, Milan, Italy.
² Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Department of Health Sciences, University of Milan, Milan, Italy.
³ Thoracic Surgery Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy.
⁴ General Surgery Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, University of Milan, Milan, Italy.

Abstract

Objective: Cardiopulmonary exercise testing (CPET) is currently recommended for all patients undergoing lung resection with either respiratory comorbidities or functional limitations. The main parameter evaluated is oxygen consumption at peak (VO₂peak). Patients with VO₂peak above 20 ml/kg/min are classified as low risk surgical candidates. The aims of this study were to evaluate postoperative outcomes of low-risk patients, and to compare their outcomes with those of patients without pulmonary impairment at respiratory function testing.

Methods: Retrospective monocentric observational study was designed, evaluating outcomes of patients undergoing lung resection at San Paolo University Hospital, Milan, Italy, between January 2016 and November 2021, preoperatively assessed by CPET, according to 2009 ERS/ESTS guidelines. All low-risk patients undergoing any extent surgical lung resection for pulmonary nodules were enrolled. Postoperative major cardiopulmonary complications or death, occurring within 30 days from surgery, were assessed. A case-control study was nested, matching 1:1 for type of surgery the cohort population with control patients without functional respiratory impairment consecutively undergoing surgery at the same centre in the study period.

Results: A total of 80 patients were enrolled: 40 subjects were preoperatively assessed by CPET and deemed at low risk, whereas 40 subjects represented the control group. Among the first, 4 patients (10%) developed major cardiopulmonary complications, and 1 patient (2.5%) died within 30 days from surgery. In the control group, 2 patients (5%) developed complications and none of the patients (0%) died. The differences in morbidity and mortality rates did not reach statistically significance. Instead, age, weight, BMI, smoking history, COPD incidence, surgical approach, FEV1, Tiffenau, DLCO and length of hospital stay resulted significantly different between the two groups. At a case-by-case analysis, CPET revealed a pathological pattern in each complicated patient, in spite of VO₂peak above target for safe surgery.

Conclusions: Postoperative outcomes of low-risk patients undergoing lung resections are comparable to those of patients without any pulmonary functional impairment; nonetheless the formers represent a dramatically different category of individuals from the latter and may harbour few patients with worse outcomes. CPET variables overall interpretation may add to the VO₂peak in identifying higher risk patients, even in this subgroup.

Keywords: VO2peak; cardiopulmonary complications; cardiopulmonary exercise testing (CPET); peak oxygen uptake; postoperative outcomes; thoracic surgery.