Daniel Baum, Monika Sombati, Lysann Rostock, Rahel Decker, Axel Rolle, Samer Etman, Dirk Koschel, Till Ploenes
{"title":"FEV1和DLCO预测肺段切除术的一般并发症，但不能预测长时间的漏气。","authors":"Daniel Baum, Monika Sombati, Lysann Rostock, Rahel Decker, Axel Rolle, Samer Etman, Dirk Koschel, Till Ploenes","doi":"10.1177/17534666251341777","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Pulmonary segmentectomy is increasingly recognized as a viable alternative to lobectomy for early stage non-small-cell lung cancer (NSCLC), offering comparable oncological outcomes with potentially reduced morbidity. Identifying reliable predictors for postoperative complications and prolonged air leak (PAL) is crucial for optimizing patient selection. While multifactorial scoring systems exist, their complexity limits clinical utility and the predictive value of single factors, such as forced expiratory volume in 1s (<i>FEV<sub>1</sub></i>) and diffusing capacity for carbon monoxide (DL<sub><i>CO</i></sub>), remains underexplored.</p><p><strong>Objectives: </strong>This study aimed to evaluate the ability of preoperative <i>FEV<sub>1</sub></i> and DL<sub><i>CO</i></sub> to predict complications (Clavien-Dindo ⩾ 3a) and PAL in patients undergoing pulmonary segmentectomy.</p><p><strong>Design: </strong>A retrospective, single-center study compared outcomes between patients undergoing segmentectomy (<i>n</i> = 33) and lobectomy (<i>n</i> = 126) for NSCLC.</p><p><strong>Methods: </strong>Patient characteristics, complication rates, and PAL incidence were analyzed. Logistic regression and ROC curve analyses assessed the predictive accuracy of <i>FEV<sub>1</sub></i> and DL<sub><i>CO</i></sub> for complications and PAL.</p><p><strong>Results: </strong>Baseline characteristics, including <i>FEV<sub>1</sub></i> and DL<sub><i>CO</i></sub>, were comparable between the segmentectomy and lobectomy groups (<i>p</i> > 0.05). <i>FEV<sub>1</sub></i> was identified as a significant predictor of complications, with lower values associated with increased risk. DL<sub><i>CO</i></sub> exhibited an even stronger predictive value for complications in the segmentectomy cohort, with an AUC of 0.924, indicating excellent predictive accuracy. In contrast, neither <i>FEV<sub>1</sub></i> nor DL<sub><i>CO</i></sub> demonstrated significant predictive value for PAL, which occurred in 30% of segmentectomy and 20% of lobectomy patients (<i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>Preoperative <i>FEV<sub>1</sub></i> and DL<sub><i>CO</i></sub> are valuable predictors of complications (Clavien-Dindo ⩾ 3a) in pulmonary segmentectomy, with DL<sub><i>CO</i></sub> showing high predictive accuracy. However, their inability to reliably predict PAL highlights the need for multifactorial models to enhance risk assessment. Despite the limited sample size, our findings align with larger studies and reinforce the clinical utility of <i>FEV<sub>1</sub></i> and DL<sub><i>CO</i></sub> for preoperative risk stratification in segmentectomy patients.</p>","PeriodicalId":22884,"journal":{"name":"Therapeutic Advances in Respiratory Disease","volume":"19 ","pages":"17534666251341777"},"PeriodicalIF":3.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246529/pdf/","citationCount":"0","resultStr":"{\"title\":\"<i>FEV<sub>1</sub></i> and DL<sub><i>CO</i></sub> predicting general complications but not prolonged air leaks in pulmonary segmentectomy.\",\"authors\":\"Daniel Baum, Monika Sombati, Lysann Rostock, Rahel Decker, Axel Rolle, Samer Etman, Dirk Koschel, Till Ploenes\",\"doi\":\"10.1177/17534666251341777\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Pulmonary segmentectomy is increasingly recognized as a viable alternative to lobectomy for early stage non-small-cell lung cancer (NSCLC), offering comparable oncological outcomes with potentially reduced morbidity. Identifying reliable predictors for postoperative complications and prolonged air leak (PAL) is crucial for optimizing patient selection. While multifactorial scoring systems exist, their complexity limits clinical utility and the predictive value of single factors, such as forced expiratory volume in 1s (<i>FEV<sub>1</sub></i>) and diffusing capacity for carbon monoxide (DL<sub><i>CO</i></sub>), remains underexplored.</p><p><strong>Objectives: </strong>This study aimed to evaluate the ability of preoperative <i>FEV<sub>1</sub></i> and DL<sub><i>CO</i></sub> to predict complications (Clavien-Dindo ⩾ 3a) and PAL in patients undergoing pulmonary segmentectomy.</p><p><strong>Design: </strong>A retrospective, single-center study compared outcomes between patients undergoing segmentectomy (<i>n</i> = 33) and lobectomy (<i>n</i> = 126) for NSCLC.</p><p><strong>Methods: </strong>Patient characteristics, complication rates, and PAL incidence were analyzed. Logistic regression and ROC curve analyses assessed the predictive accuracy of <i>FEV<sub>1</sub></i> and DL<sub><i>CO</i></sub> for complications and PAL.</p><p><strong>Results: </strong>Baseline characteristics, including <i>FEV<sub>1</sub></i> and DL<sub><i>CO</i></sub>, were comparable between the segmentectomy and lobectomy groups (<i>p</i> > 0.05). <i>FEV<sub>1</sub></i> was identified as a significant predictor of complications, with lower values associated with increased risk. DL<sub><i>CO</i></sub> exhibited an even stronger predictive value for complications in the segmentectomy cohort, with an AUC of 0.924, indicating excellent predictive accuracy. In contrast, neither <i>FEV<sub>1</sub></i> nor DL<sub><i>CO</i></sub> demonstrated significant predictive value for PAL, which occurred in 30% of segmentectomy and 20% of lobectomy patients (<i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>Preoperative <i>FEV<sub>1</sub></i> and DL<sub><i>CO</i></sub> are valuable predictors of complications (Clavien-Dindo ⩾ 3a) in pulmonary segmentectomy, with DL<sub><i>CO</i></sub> showing high predictive accuracy. However, their inability to reliably predict PAL highlights the need for multifactorial models to enhance risk assessment. Despite the limited sample size, our findings align with larger studies and reinforce the clinical utility of <i>FEV<sub>1</sub></i> and DL<sub><i>CO</i></sub> for preoperative risk stratification in segmentectomy patients.</p>\",\"PeriodicalId\":22884,\"journal\":{\"name\":\"Therapeutic Advances in Respiratory Disease\",\"volume\":\"19 \",\"pages\":\"17534666251341777\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246529/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Therapeutic Advances in Respiratory Disease\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/17534666251341777\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/7/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"RESPIRATORY SYSTEM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Respiratory Disease","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17534666251341777","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/7/7 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
FEV1 and DLCO predicting general complications but not prolonged air leaks in pulmonary segmentectomy.
Background: Pulmonary segmentectomy is increasingly recognized as a viable alternative to lobectomy for early stage non-small-cell lung cancer (NSCLC), offering comparable oncological outcomes with potentially reduced morbidity. Identifying reliable predictors for postoperative complications and prolonged air leak (PAL) is crucial for optimizing patient selection. While multifactorial scoring systems exist, their complexity limits clinical utility and the predictive value of single factors, such as forced expiratory volume in 1s (FEV1) and diffusing capacity for carbon monoxide (DLCO), remains underexplored.
Objectives: This study aimed to evaluate the ability of preoperative FEV1 and DLCO to predict complications (Clavien-Dindo ⩾ 3a) and PAL in patients undergoing pulmonary segmentectomy.
Design: A retrospective, single-center study compared outcomes between patients undergoing segmentectomy (n = 33) and lobectomy (n = 126) for NSCLC.
Methods: Patient characteristics, complication rates, and PAL incidence were analyzed. Logistic regression and ROC curve analyses assessed the predictive accuracy of FEV1 and DLCO for complications and PAL.
Results: Baseline characteristics, including FEV1 and DLCO, were comparable between the segmentectomy and lobectomy groups (p > 0.05). FEV1 was identified as a significant predictor of complications, with lower values associated with increased risk. DLCO exhibited an even stronger predictive value for complications in the segmentectomy cohort, with an AUC of 0.924, indicating excellent predictive accuracy. In contrast, neither FEV1 nor DLCO demonstrated significant predictive value for PAL, which occurred in 30% of segmentectomy and 20% of lobectomy patients (p > 0.05).
Conclusion: Preoperative FEV1 and DLCO are valuable predictors of complications (Clavien-Dindo ⩾ 3a) in pulmonary segmentectomy, with DLCO showing high predictive accuracy. However, their inability to reliably predict PAL highlights the need for multifactorial models to enhance risk assessment. Despite the limited sample size, our findings align with larger studies and reinforce the clinical utility of FEV1 and DLCO for preoperative risk stratification in segmentectomy patients.
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