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Communications to the Editor |

Prolonged Air Leak Following Upper Lobectomy : In Search of the Key FREE TO VIEW

Alessandro Brunelli Aroldo Fianchini, MD, MD
Author and Funding Information

University of Ancona, Ancona, Italy

Correspondence to: Alessandro Brunelli, MD, Via S. Margherita 23, 60129 Ancona, Italy; email: alexit@freemail.it



Chest. 1999;116(3):848. doi:10.1378/chest.116.3.848
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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 resection.

References

Abolhoda, A, Liu, D, Brooks, A, et al (1998) Prolonged air leak following radical upper lobectomy: an analysis of incidence and possible risk factors.Chest113,1507-1510. [PubMed] [CrossRef]
 
Kearney, DJ, Lee, TH, Reilly, JJ, et al Assessment of operative risk in patients undergoing lung resection: importance of predicted pulmonary function.Chest1994;105,753-759. [PubMed]
 
Brunelli, A, Fianchini, A Predicted postoperative FEV1and complications in lung resection candidates.Chest1997;111,1145-1146. [PubMed]
 

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References

Abolhoda, A, Liu, D, Brooks, A, et al (1998) Prolonged air leak following radical upper lobectomy: an analysis of incidence and possible risk factors.Chest113,1507-1510. [PubMed] [CrossRef]
 
Kearney, DJ, Lee, TH, Reilly, JJ, et al Assessment of operative risk in patients undergoing lung resection: importance of predicted pulmonary function.Chest1994;105,753-759. [PubMed]
 
Brunelli, A, Fianchini, A Predicted postoperative FEV1and complications in lung resection candidates.Chest1997;111,1145-1146. [PubMed]
 
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