This study aimed to clarify the predictive value of preoperative peak VO2 for PPC and explore factors related to PPC in lung cancer patients with COPD.
This single-center retrospective cohort study included 40 patients with lung cancer complicated by COPD who underwent a preoperative cardiopulmonary exercise test between January 2017 and August 2024. Patients were divided into those with and without PPC (PPC and non-PPC groups, respectively). Clinical parameters such as surgical approach, pulmonary function, and peak VO2 were compared between the groups. The association between these parameters and PPC was analyzed using multivariable logistic regression.
The peak VO2 was significantly lower in the PPC group than in the non-PPC group (p0.01), while the ventilatory equivalent/ventilatory carbon dioxide slope (VE/VCO2-slope) was significantly higher in the PPC group than in the non-PPC group (p0.05). In addition, Significant differences were also observed in the sex and surgical approach (p0.05 and p0.05, respectively). In the multivariable logistic analysis including the % diffusing capacity of the lung for carbon monoxide (DLCO), predicted postoperative % DLCO, forced expiratory volume in 1 second(%FEV1), predicted postoperative %FEV1, peak VO2, and VE/VCO2-slope, Surgical approach, only peak VO2 was identified as a significant independent factor for predicting PPC. The area under the receiver operating characteristic curve of peak VO2 to predict PPC was 0.92, with a cutoff value of 13.7 mL/min/kg, sensitivity of 94%, and specificity of 78%.
This study revealed that peak VO2, was the most important parameter for predicting PPC in lung cancer patients with COPD.
Incorporating cardiopulmonary exercise tests into preoperative assessments could improve risk stratification and perioperative management, potentially reducing the incidence of PPC in this high-risk population.
Postoperative Pulmonary Complications
Peak VO2
