Abstract
Chronic obstructive pulmonary disease (COPD), an established risk factor for lung cancer, remains largely undiagnosed and untreated before lung cancer surgery. We evaluated the effect of perioperative bronchodilator therapy on lung function changes in COPD patients who underwent surgery for non-small cell lung cancer (NSCLC). From a database including NSCLC patients undergoing lung resection, COPD patients were identified and divided into two groups based on the use of bronchodilator during the pre- and post-operative period. Changes in forced expiratory volume in 1 s (FEV1) and postoperative complications were compared between patients treated with and without bronchodilators. Among 268 COPD patients, 112 (41.8%) received perioperative bronchodilator, and 75% (84/112) were newly diagnosed with COPD before surgery. Declines in FEV1 after surgery were alleviated by perioperative bronchodilator even after adjustments for related confounding factors including surgical extent, surgical approach and preoperative FEV1 (adjusted mean difference in FEV1 decline [95% CI] between perioperative bronchodilator group and no perioperative bronchodilator group; − 161.1 mL [− 240.2, − 82.0], − 179.2 mL [− 252.1, − 106.3], − 128.8 mL [− 193.2, − 64.4] at 1, 4, and 12 months after surgery, respectively). Prevalence of postoperative complications was similar between two groups. Perioperative bronchodilator therapy was effective to preserve lung function, after surgery for NSCLC in COPD patients. An active diagnosis and treatment of COPD are required for surgical candidates of NSCLC.
Highlights
Chronic obstructive pulmonary disease (COPD), an established risk factor for lung cancer, remains largely undiagnosed and untreated before lung cancer surgery
During the follow-up, a greater decline in F EV1 [95% confidence interval (CI)] was observed in patients not treated with perioperative bronchodilator compared with those who received perioperative bronchodilator at 1 month [− 161.1 mL (− 240.2, − 82.0); P < 0.001], 4 months [− 179.2 mL (− 252.1, − 106.3); P < 0.001], and 12 months [− 128.8 mL (− 193.2, − 64.4); P < 0.001] after surgery, respectively (Table 2)
When we assessed % pred FEV1, participants treated without a perioperative bronchodilator showed larger decline of − 5.5% (− 8.0, − 2.9), − 6.1% (− 8.6, − 3.7), and − 4.6% (− 6.9, − 2.3) in % pred F EV1 at 1, 4, and 12 months after surgery, respectively than participants treated with perioperative bronchodilators (Table 2 and Fig. 1)
Summary
Chronic obstructive pulmonary disease (COPD), an established risk factor for lung cancer, remains largely undiagnosed and untreated before lung cancer surgery. We evaluated the effect of perioperative bronchodilator therapy on lung function changes in COPD patients who underwent surgery for non-small cell lung cancer (NSCLC). Perioperative bronchodilator therapy was effective to preserve lung function, after surgery for NSCLC in COPD patients. Chronic obstructive pulmonary disease (COPD) is an independent risk factor for lung cancer development and the most frequent concomitant disease in patients with early stage non-small cell lung cancer (NSCLC)[2,3]. Surgical resection remains as the cornerstone of curative treatment in early stage NSCLC4, patients with COPD are often precluded from lung cancer surgery due to inevitable deteriorations in pulmonary function and the increased risk of postoperative pulmonary complications (PPC) and poor outcome following lung r esection[5,6,7]. Cancer indicates that these patients have not been treated for COPD and can result in inadequate management as these patients will not benefit from bronchodilator treatments
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
