Key result
Higher preoperative PA/AA ratio linked to ~130% greater cardiopulmonary complications after lung cancer surgery.
Why the study?
Pulmonary arterial enlargement on computed tomography has been associated with pulmonary hypertension, a known risk factor for thoracic surgery, but its predictive value for cardiopulmonary complications after lung cancer resection was unclear.
Cohort (n=237)
Single-blind
No
Warrants caution in high-ratio patients for lung cancer resection; leaves open prospective validation before risk-stratification use.
BACKGROUND: The finding of pulmonary arterial enlargement on computed tomography has been reported to be associated with pulmonary hypertension. On the other hand, pulmonary hypertension is a known risk factor for thoracic surgery. We investigated whether pulmonary arterial enlargement predicts cardiopulmonary complications following pulmonary resection for lung cancer. METHODS: We reviewed 237 consecutive patients who underwent pulmonary resection for lung cancer. Preoperative patient characteristics (sex, age, Brinkman index, cardiopulmonary comorbidities, cardiothoracic ratio, pulmonary function, and pulmonary arterial enlargement) and surgical data (surgical procedure, pathological stage, postoperative complications, mortality, and length of postoperative hospital stay) were analyzed. In order to evaluate preoperative pulmonary arterial enlargement, we measured the diameter of the main pulmonary artery at its bifurcation and that of the ascending aorta at its widest point using chest computed tomography and calculated the ratio of the former diameter to the latter. RESULTS: In all, 16 patients developed postoperative cardiopulmonary complications and 221 did not. One patient died from postoperative pneumonia. The mean age of patients who developed postoperative cardiopulmonary complications was significantly higher than that of those who did not (78 ± 5 years vs 69 ± 9 years, P=0.0001). The pulmonary artery-to-ascending-aorta ratio was significantly higher in patients who developed postoperative complications than in those who did not (0.94 ± 0.15 vs. 0.81 ± 0.11, P=0.03). Other preoperative patient characteristics and surgical data did not differ significantly between the groups. On multivariate analysis, pulmonary artery-to-ascending-aorta ratio (0.1-point increase; odds ratio 2.3, 95 % confidence interval 1.5-3.5; P=0.0002) and age (1-year increase; odds ratio 1.2, 95 % confidence interval 1.1-1.3; P=0.03) were found to be independent predictors of postoperative cardiopulmonary complications. CONCLUSIONS: A finding of pulmonary arterial enlargement on computed tomography is a potential predictor of postoperative cardiopulmonary complications after lung cancer surgery.
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Asakura et al. (2015) conducted a cohort in Primary lung cancer (n=237). Pulmonary arterial enlargement (PA/A ratio) vs. Normal pulmonary artery size (PA/A ratio ≤1.0) was evaluated on Postoperative cardiopulmonary complications (OR 2.3, 95% CI 1.5-3.5, p=0.0002). A 0.1-point increase in the preoperative pulmonary artery-to-ascending-aorta ratio independently predicted postoperative cardiopulmonary complications (OR 2.3) after lung cancer surgery.
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