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 and Main 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.