Significance of the lobe-specific emphysema index to predict prolonged air leak after anatomical segmentectomy


Autoři: Duk Hwan Moon aff001;  Chul Hwan Park aff002;  Du-Young Kang aff003;  Hye Sun Lee aff004;  Sungsoo Lee aff001
Působiště autorů: Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea aff001;  Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea aff002;  Department of Cardiovascular and Thoracic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea aff003;  Biostatics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224519

Souhrn

Prolonged air leak (PAL) is a major complication of pulmonary resection. Emphysema quantification with computed tomography is regarded as an important predictor of PAL for patients undergoing lobectomy. Therefore, we investigated whether this predictor might be applicable for segmentectomy. Herein, we characterized the factors that influence PAL in early stage lung cancer patients undergoing anatomical segmentectomy. Forty-one patients who underwent anatomical segmentectomy for early lung cancer between January 2014 and July 2017 were included for analysis. Several baseline and surgical variables were evaluated. In particular, the emphysema index (EI, %) and lobe-specific emphysema index (LEI, %) were assessed by using three-dimensional volumetric CT scan. PAL was observed in 13 patients (31.7%). There were statistically significant differences in DLCO (97.3% ± 18.3% vs. 111.7% ± 15.9%, p = 0.014), EI (4.61% ± 4.66% vs. 1.17% ± 1.76%, p = 0.023), and LEI (5.81% ± 5.78% vs. 0.76% ± 1.17%, p = 0.009) between patients with and without PAL. According to logistic regression analysis, both EI and LEI were significantly associated with PAL (p = 0.028 and p < 0.001, respectively). We found that EI and LEI significantly influenced the development of PAL after pulmonary resection. In particular, LEI showed stronger association with PAL, compared with EI, suggesting the importance of LEI in the prediction of PAL after anatomical segmentectomy.

Klíčová slova:

Computed axial tomography – Hospitals – Lung and intrathoracic tumors – Lung resection – Pulmonary imaging – Surgical and invasive medical procedures – Emphysema – Lobectomy


Zdroje

1. Brunelli A, Drosos P, Dinesh P, Ismail H, Bassi V. The Severity of Complications Is Associated With Postoperative Costs After Lung Resection. Ann Thorac Surg. 2017;103: 1641–1646. doi: 10.1016/j.athoracsur.2016.10.061 28189276

2. Brunelli A, Varela G, Refai M, Jimenez MF, Pompili C, Sabbatini A, et al. A Scoring System to Predict the Risk of Prolonged Air Leak After Lobectomy. The Annals of Thoracic Surgery. 2010;90: 204–209. https://doi.org/10.1016/j.athoracsur.2010.02.054 20609776

3. Cerfolio RJ, Bass CS, Harrison Pask A, Katholi CR. Predictors and treatment of persistent air leaks. The Annals of Thoracic Surgery. 2002;73: 1727–1731. https://doi.org/10.1016/S0003-4975(02)03531-2 12078760

4. Droghetti A, Schiavini A, Muriana P, Folloni A, Picarone M, Bonadiman C, et al. A prospective randomized trial comparing completion technique of fissures for lobectomy: stapler versus precision dissection and sealant. J Thorac Cardiovasc Surg. 2008;136: 383–391. doi: 10.1016/j.jtcvs.2008.04.014 18692646

5. Attaar A, Winger DG, Luketich JD, Schuchert MJ, Sarkaria IS, Christie NA, et al. A clinical prediction model for prolonged air leak after pulmonary resection. J Thorac Cardiovasc Surg. 2017;153: 690–699.e692. doi: 10.1016/j.jtcvs.2016.10.003 27912898

6. Brunelli A, Salati M, Pompili C, Gentili P, Sabbatini A. Intraoperative air leak measured after lobectomy is associated with postoperative duration of air leak. European Journal of Cardio-Thoracic Surgery. 2017;52: 963–968. doi: 10.1093/ejcts/ezx105 28444366

7. Petrella F, Rizzo S, Radice D, Borri A, Galetta D, Gasparri R, et al. Predicting prolonged air leak after standard pulmonary lobectomy: Computed tomography assessment and risk factors stratification. The Surgeon. 2011;9: 72–77. https://doi.org/10.1016/j.surge.2010.07.010 21342670

8. Ketchedjian A, Daly B, Landreneau R, Fernando H. Sublobar resection for the subcentimeter pulmonary nodule. Semin Thorac Cardiovasc Surg. 2005;17: 128–133. doi: 10.1053/j.semtcvs.2005.04.003 16087080

9. Kim SS, Jin GY, Li YZ, Lee JE, Shin HS. CT Quantification of Lungs and Airways in Normal Korean Subjects. Korean J Radiol. 2017;18: 739–748. doi: 10.3348/kjr.2017.18.4.739 28670169

10. The definition of emphysema. Report of a National Heart, Lung, and Blood Institute, Division of Lung Diseases workshop. Am Rev Respir Dis. 1985;132: 182–185. doi: 10.1164/arrd.1985.132.1.182 4014865

11. Muller NL, Staples CA, Miller RR, Abboud RT. "Density mask". An objective method to quantitate emphysema using computed tomography. Chest. 1988;94: 782–787 doi: 10.1378/chest.94.4.782 3168574

12. Coxson HO, Dirksen A, Edwards LD, Yates JC, Agusti A, Bakke P, et al. The presence and progression of emphysema in COPD as determined by CT scanning and biomarker expression: a prospective analysis from the ECLIPSE study. Lancet Respir Med. 2013;1: 129–136. doi: 10.1016/S2213-2600(13)70006-7 24429093

13. Lynch DA, Al-Qaisi MA. Quantitative computed tomography in chronic obstructive pulmonary disease. J Thorac Imaging. 2013;28: 284–290. doi: 10.1097/RTI.0b013e318298733c 23748651

14. Wang Z, Gu S, Leader JK, Kundu S, Tedrow JR, Sciurba FC, et al. Optimal threshold in CT quantification of emphysema. Eur Radiol. 2013;23: 975–984. doi: 10.1007/s00330-012-2683-z 23111815

15. Muto S, Kawano H, Isotani S, Ide H, Horie S. Novel semi-automated kidney volume measurements in autosomal dominant polycystic kidney disease. Clin Exp Nephrol. 2017. doi: 10.1007/s10157-017-1486-6 29101551

16. Cho JS, Jheon S, Park SJ, Sung SW, Lee CT. Outcome of limited resection for lung cancer. Korean J Thorac Cardiovasc Surg. 2011;44: 51–57. doi: 10.5090/kjtcs.2011.44.1.51 22263124

17. Okada M, Tsutani Y, Ikeda T, Misumi K, Matsumoto K, Yoshimura M, et al. Radical hybrid video-assisted thoracic segmentectomy: long-term results of minimally invasive anatomical sublobar resection for treating lung cancer. Interact Cardiovasc Thorac Surg. 2012;14: 5–11. doi: 10.1093/icvts/ivr065 22108951

18. Shimizu K, Nakano T, Kamiyoshihara M, Takeyoshi I. Segmentectomy guided by three-dimensional computed tomography angiography and bronchography. Interact Cardiovasc Thorac Surg. 2012;15: 194–196. doi: 10.1093/icvts/ivs202 22593563

19. Ghaly G, Kamel M, Nasar A, Paul S, Lee PC, Port JL, et al. Video-Assisted Thoracoscopic Surgery Is a Safe and Effective Alternative to Thoracotomy for Anatomical Segmentectomy in Patients With Clinical Stage I Non-Small Cell Lung Cancer. Ann Thorac Surg. 2016;101: 465–472; discussion 472. doi: 10.1016/j.athoracsur.2015.06.112 26391692

20. Sienel W, Dango S, Kirschbaum A, Cucuruz B, Horth W, Stremmel C, et al. Sublobar resections in stage IA non-small cell lung cancer: segmentectomies result in significantly better cancer-related survival than wedge resections. Eur J Cardiothorac Surg. 2008;33: 728–734. doi: 10.1016/j.ejcts.2007.12.048 18261918

21. Fabian T, Federico JA, Ponn RB. Fibrin glue in pulmonary resection: a prospective, randomized, blinded study. The Annals of Thoracic Surgery. 2003;75: 1587–1592. doi: 10.1016/s0003-4975(02)04994-9 12735583

22. Moser C, Opitz I, Zhai W, Rousson V, Russi EW, Weder W, et al. Autologous fibrin sealant reduces the incidence of prolonged air leak and duration of chest tube drainage after lung volume reduction surgery: a prospective randomized blinded study. J Thorac Cardiovasc Surg. 2008;136: 843–849. doi: 10.1016/j.jtcvs.2008.02.079 18954621

23. Ng T, Ryder BA, Machan JT, Cioffi WG. Decreasing the incidence of prolonged air leak after right upper lobectomy with the anterior fissureless technique. J Thorac Cardiovasc Surg. 2010;139: 1007–1011. doi: 10.1016/j.jtcvs.2009.07.023 19683728


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2019 Číslo 11