Effects of preoperative pulmonary function on perioperative outcomes after robotic-assisted pulmonary lobectomy

Collin B Chase; Rahul Mhaskar; Cole Fiedler; William J West 3rd; Ajay Varadhan; Jessica Cobb; Sarah Cool; Gregory Fishberger; Maykel Dolorit; Emily E Weeden; Harrison E Strang; Diep Nguyen; Joseph R Garrett; Carla C Moodie; Jacques P Fontaine; Jenna R Tew; Jobelle J A R Baldonado; Eric M Toloza

doi:10.1016/j.amjsurg.2023.02.016

Effects of preoperative pulmonary function on perioperative outcomes after robotic-assisted pulmonary lobectomy

Am J Surg. 2023 Jul;226(1):128-132. doi: 10.1016/j.amjsurg.2023.02.016. Epub 2023 Mar 1.

Authors

Collin B Chase¹, Rahul Mhaskar², Cole Fiedler³, William J West 3rd⁴, Ajay Varadhan⁵, Jessica Cobb⁶, Sarah Cool⁷, Gregory Fishberger⁸, Maykel Dolorit⁹, Emily E Weeden¹⁰, Harrison E Strang¹¹, Diep Nguyen¹², Joseph R Garrett¹³, Carla C Moodie¹⁴, Jacques P Fontaine¹⁵, Jenna R Tew¹⁶, Jobelle J A R Baldonado¹⁷, Eric M Toloza¹⁸

Affiliations

¹ Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: cbchase@usf.edu.
² Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; Department of Internal Medicine, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: rmhaskar@usf.edu.
³ Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: colefiedler@usf.edu.
⁴ Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: westw@usf.edu.
⁵ Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: ajayvaradhan@usf.edu.
⁶ Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: cobb3@usf.edu.
⁷ Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: cool@usf.edu.
⁸ Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: gfishberger@usf.edu.
⁹ Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: dolorit@usf.edu.
¹⁰ Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: eeweeden@usf.edu.
¹¹ Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: harrisonelliotstrang@usf.edu.
¹² Department of Medical Education, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: diepnguyen@usf.edu.
¹³ Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA. Electronic address: joe.garrett@moffitt.org.
¹⁴ Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA. Electronic address: carla.moodie@moffitt.org.
¹⁵ Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA; Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: jacques.fontaine@moffitt.org.
¹⁶ Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA. Electronic address: jenna.tew@moffitt.org.
¹⁷ Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA; Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: jobelle.baldonado@moffitt.org.
¹⁸ Department of Thoracic Oncology, Moffitt Cancer Center, Tampa, FL, USA; Department of Surgery, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; Department of Oncologic Sciences, University of South Florida Health Morsani College of Medicine, Tampa, FL, USA. Electronic address: eric.toloza@moffitt.org.

PMID: 37121787
DOI: 10.1016/j.amjsurg.2023.02.016

Abstract

Introduction: Effects of pulmonary function test (PFT) results on perioperative outcomes were investigated after robotic-assisted video-thoracoscopic (RAVT) pulmonary lobectomy.

Methods: We retrospectively analyzed 706 consecutive patients who underwent RAVT lobectomy by one surgeon over 10.8 years. Preoperative (preop) forced expiratory volume in 1 s as a percent of predicted (FEV1%) was used to group patients as having normal FEV1% (≥80%) versus reduced FEV1% (<80%). Demographics, preop comorbidities, intraoperative (intraop) and postoperative (postop) complications, perioperative outcomes, and median survival time (MST) were compared across patients with normal vs. reduced FEV1% using Chi-Square (X²), Fisher's Exact test, Student's t-test, Kruskal-Wallis test, or Kaplan-Meier analysis respectively, with significance at p ≤ 0.05. Multivariable analysis was performed for perioperative outcomes to investigate the differences across patients in the FEV1% groups.

Results: There were 470 patients with normal FEV1% and 236 patients with reduced FEV1%. The two FEV1% groups did not differ in intraop or postop complication rates, except for higher postop other arrhythmia requiring intervention (p = 0.004), prolonged air leak >5 days (p = 0.002), mucous plug formation (p = 0.009), hypoxia (p < 0.001), and pneumonia (p = 0.002), and total postop complications (p < 0.001) in reduced-FEV1% patients. Reduced FEV1% correlated with increased intraop estimated blood loss (p < 0.0001) and skin-to-skin operative time (p < 0.0001). Median overall survival in patients with normal FEV1% was 93.20 months (95% CI: 76.5-126.0) versus 58.9 months (95% CI: 50.4-68.4) in patients with reduced FEV1% (p = 0.0004).

Conclusion: Patients should have PFTs conducted before surgery to determine at-risk patients. However, RAVT pulmonary lobectomy is feasible and safe even in patients with reduced FEV1%.

Keywords: Lobectomy; Outcomes; Pulmonary function; Robotic.

MeSH terms

Humans
Lung Diseases / surgery
Lung Neoplasms / surgery
Lung*
Pneumonectomy / methods
Retrospective Studies
Robotic Surgical Procedures*
Thoracic Surgery, Video-Assisted