University of Ancona, Ancona, Italy
Correspondence to: Alessandro Brunelli, MD, Via S. Margherita 23, 60129 Ancona, Italy; email: email@example.com
Severe chronic obstructive pulmonary disease (COPD) predisposes
patients undergoing lung resection to prolonged air leak (PAL) because
of increased airways resistance and pathologic parenchymal changes.
Upper lobectomies are particularly at risk for this complication
because of the frequently associated residual pleural air space.
Although this well-known conclusion has been generated in the recent
study of Abolhoda and colleagues,1 the spirometric
parameters used to substantiate their statistical analysis have been,
in our view, improperly chosen and, thus, yielded weak results.
In lung cancer patients, preoperative spirometric data may be
affected by the volume of the neoplasm, the associated atelectasis, and
the consequent ventilation/perfusion mismatch. We think predicted
postoperative FEV1 calculated on the basis of the number of
functioning segments removed during surgery2 is a better
indicator of preexisting COPD and, thus, a more reliable predictor of
postoperative respiratory complications, including PAL.
In our series of 133 consecutive upper lobectomies in the last 6 years
(77 right and 56 left), PAL was the most frequent postoperative
complication and it was present in 22% of cases, a result similar to
that of Abolhoda and colleagues.1 Predicted postoperative
FEV1% was the only spirometric variable statistically
associated with PAL (64.7% ± 14.5 SD in patients with PAL vs
74% ± 18 SD in patients without PAL; p = 0.04, Student’s
t test). FEV1, FVC, and FEV1/FVC
(the latter was the only factor significantly predictive of PAL in the
work of Abolhoda and colleagues,1) were not statistically
different between patients who developed PAL and patients who didn’t.
This discrepancy may be a result of the different methodologic
approach, since our results were expressed as percentage of predicted
values for age, sex, and body surface area. In fact, we consider
absolute spirometric values, such as those reported by Abolhoda and
colleagues,1 inappropriate for evaluation.3
We think the discrepancy may be better explained by the greater
appropriateness of predicted postoperative FEV1 with
respect to preoperative spirometric data in the evaluation of lung
cancer patients with COPD and thus at increased risk for PAL after lung
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