PURPOSE: Compare functional outcomes and quality of life after lung cancer pulmonary lobectomy between high risk (HR) & low risk (LR) patients.
METHODS: Curative-intent lung cancer lobectomies with staging lymphadenectomy were analyzed. Data was collected preoperatively (preop), during hospitalization and 6 months postoperatively (postop). Patients completed the Short Form 36 Health Survey (SF36) and Ferrans and Powers Quality of Life Index (QLI) preop and postop. Patients were stratified as LR when predicted postoperative (ppo) diffusion capacity (DLCO) & ppo FEV1 > 40 and HR when either < 40.
RESULTS: 198 total patients included LR-166 & HR-32. Preop HR patients: older: (68.5 vs 63.9 yrs; p=0.03); worse performance status (PS) (1.1 vs 0.4; p=0.00); worse pulmonary function testing (PFTs) (FEV1 pred 62% vs 81%; FVC 2.8 vs 3.3 L; FVC pred 80% vs 89%; DLCO pred 52% vs 77% p=0.00 - 0.01). There was no difference in operating time, transfusion, postop complications or discharge site except less video-assisted thoracic surgery (VATS)(HR: 9.4% vs LR: 29.5%; p=0.02); pathologic stage (HR:1A-19% 1B-50%; LR:1A-43% 1B-22%; p=0.02); ventricular arrhythmias requiring treatment (3.1% vs 0%; p=0.02). HR vs LR patients did not differ regarding hospital mortality (3.1% vs 1.8%; p=0.63), any postop complication or 6-month mortality (6.3% vs 6.6%; p=0.94). Mean (days±SD) /median hospital length of stay (LOS) was longer for HR (7.8±3.8 / 6 vs 6.3±5 / 5; p< 0.001). HR at 6 months: less FEV1 decrease (-2.2 vs -10.1; p=0.02) & greater MRC dyspnea index (0.76 vs 0.31; p=0.03). There was no difference in chronic pain, need for pain meds, change in PS, hospital readmission or living site. There was no difference in absolute values or magnitude of change in any SF36 category or QLI subscale for HR vs LR preop vs postop.
CONCLUSION: This observational study shows preoperative risk stratification for pulmonary lobectomy predicts increased hospital LOS and greater postop dyspnea.
CLINICAL IMPLICATIONS: Preop risk does not affect functional health status or quality of life 6 months after lobectomy for cancer.
DISCLOSURE: John Handy, Jr, No Financial Disclosure Information; No Product/Research Disclosure Information