Prediction formula for predicted diffusion capacity of lung for carbon monoxide in pulmonary surgery.

Abstract

Diffusion capacity of the lung for carbon monoxide (DLCO) is a useful value for perioperative risk assessment of non-small cell lung cancer (NSCLC). The percentage of the predicted DLCO (%DLCO: DLCO/predicted DLCO × 100) is often evaluated by setting cutoff values as in the clinical field, but several formulae are available for calculating the predicted DLCO, and the %DLCO thus varies depending on the formula used to predict DLCO. We examined differences in %DLCO calculated using several commonly used prediction formulae. A total of 490 eligible patients who underwent completed video-assisted thoracoscopic surgery (c-VATS), especially radical pulmonary lobectomy, for NSCLC were analyzed retrospectively. Predicted DLCO was calculated using the prediction formulae described by Burrows, Nishida, Cotes, and Kanagami, then the relationships with postoperative complications were evaluated. The %DLCO from Nishida's formula was two-thirds the value of that from Burrows' (p < 0.05). On logistic regression analysis, predicted postoperative %DLCO (ppo-DLCO) based on the formulae of Burrows, Cotes and Kanagami were independent factors related to postoperative pulmonary complications after c-VATS lobectomy for NSCLC (odds ratios 2.46, 1.79 and 2.33, p = 0.005, 0.043 and 0.009, respectively). The %DLCO is a useful index for surgical risk assessment of c-VATS lobectomy for NSCLC, while the results differ markedly between individual prediction formulae. Specification of the formula used is necessary in cases considering risk evaluations.