Hyun Lee1, Hong Kwan Kim2, Danbee Kang3, Sunga Kong4, Jae Kyung Lee5, Genehee Lee5, Sumin Shin2, Juhee Cho6, Jae Ill Zo2, Young Mog Shim2, Hye Yun Park7. 1. Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea. 2. Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 3. Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. 4. Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea; Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea. 5. Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, South Korea. 6. Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea; Department of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 7. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Electronic address: hyeyunpark@skku.edu.
Abstract
BACKGROUND: The risk stratification value of the 6-min walk test (6MWT) to decide the feasibility of surgical resection is not well elucidated in patients with non-small cell lung cancer (NSCLC) and moderately decreased lung function. OBJECTIVE: This study aimed to determine the role of the 6MWT in predicting postoperative cardiopulmonary complications in patients with NSCLC who underwent lobectomy and had moderately decreased lung function. METHODS: The data were obtained from a prospective cohort study called Coordinate Approach to Cancer Patient's Health for Lung Cancer (CATCH-LUNG). Patients who underwent lobectomy for NSCLC were classified into two groups according to predicted postoperative pulmonary function (low-risk group or moderate-risk group); each group was then further classified into short-distance (< 400 m) or long-distance (≥ 400 m) groups according to a 6-min walk distance. The main end point of this study was the incidence of postoperative cardiopulmonary complications occurring within the first 30 postoperative days. A multivariable logistic regression model was used to compare the postoperative cardiopulmonary complications among the four groups. RESULTS: The adjusted ORs for any postoperative pulmonary complications, postoperative cardiac complications, and postoperative cardiopulmonary complications in patients with moderate-risk/short-distance relative to those with low-risk/long-distance were 10.26 (95% CI, 2.37-44.36), 5.65 (95% CI, 1.39-22.90), and 7.84 (95% CI, 2.24-27.46), respectively. However, these complications were not different between the patients with moderate-risk/long-term distance and those with low-risk/long-distance. Among patients in the moderate-risk group, those in the short-distance group had a significantly higher risk of postoperative cardiopulmonary complications compared with those in the long-distance group (adjusted OR, 4.95; 95% CI, 1.37-17.93). CONCLUSIONS: Patients with NSCLC with moderate-risk/short-distance were at greater risk of developing postoperative cardiopulmonary complications; it may be feasible, however, for patients with NSCLC and moderate-risk/long-distance to undergo lobectomy compared with those with low-risk/long-distance. Our study suggests that the 6MWT could provide additional information in identifying optimal candidates for lung resection surgery of NSCLC. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03705546; URL: www.clinicaltrials.gov.
BACKGROUND: The risk stratification value of the 6-min walk test (6MWT) to decide the feasibility of surgical resection is not well elucidated in patients with non-small cell lung cancer (NSCLC) and moderately decreased lung function. OBJECTIVE: This study aimed to determine the role of the 6MWT in predicting postoperative cardiopulmonary complications in patients with NSCLC who underwent lobectomy and had moderately decreased lung function. METHODS: The data were obtained from a prospective cohort study called Coordinate Approach to CancerPatient's Health for Lung Cancer (CATCH-LUNG). Patients who underwent lobectomy for NSCLC were classified into two groups according to predicted postoperative pulmonary function (low-risk group or moderate-risk group); each group was then further classified into short-distance (< 400 m) or long-distance (≥ 400 m) groups according to a 6-min walk distance. The main end point of this study was the incidence of postoperative cardiopulmonary complications occurring within the first 30 postoperative days. A multivariable logistic regression model was used to compare the postoperative cardiopulmonary complications among the four groups. RESULTS: The adjusted ORs for any postoperative pulmonary complications, postoperative cardiac complications, and postoperative cardiopulmonary complications in patients with moderate-risk/short-distance relative to those with low-risk/long-distance were 10.26 (95% CI, 2.37-44.36), 5.65 (95% CI, 1.39-22.90), and 7.84 (95% CI, 2.24-27.46), respectively. However, these complications were not different between the patients with moderate-risk/long-term distance and those with low-risk/long-distance. Among patients in the moderate-risk group, those in the short-distance group had a significantly higher risk of postoperative cardiopulmonary complications compared with those in the long-distance group (adjusted OR, 4.95; 95% CI, 1.37-17.93). CONCLUSIONS:Patients with NSCLC with moderate-risk/short-distance were at greater risk of developing postoperative cardiopulmonary complications; it may be feasible, however, for patients with NSCLC and moderate-risk/long-distance to undergo lobectomy compared with those with low-risk/long-distance. Our study suggests that the 6MWT could provide additional information in identifying optimal candidates for lung resection surgery of NSCLC. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT03705546; URL: www.clinicaltrials.gov.
Authors: Sumin Shin; Sunga Kong; Danbee Kang; Hong Kwan Kim; Hye Yun Park; Genehee Lee; Jong Ho Cho; Young Mog Shim; Juhee Cho Journal: Respir Res Date: 2022-08-30