Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting β2 agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients.MethodsBetween January 2005 and October 2019, 130 consecutive patients with newly diagnosed COPD underwent surgery for lung cancer. We conducted a retrospective review of their medical record to evaluate that LAMA/LABA might be an optimal regimen for patients with COPD undergoing surgery for lung cancer. All patients were received perioperative rehabilitation and divided into 3 groups according to the type of perioperative inhaled therapy and management: LAMA/LABA (n = 64), LAMA (n = 23) and rehabilitation only (no bronchodilator) (n = 43). We conducted a retrospective review of their medical records.ResultsPatients who received preoperative LAMA/LABA therapy showed significant improvement in lung function before surgery (p < 0.001 for both forced expiratory volume in 1 s (FEV1) and percentage of predicted forced expiratory volume in 1 s (FEV1%pred). Compared with patients who received preoperative LAMA therapy, patients with LAMA/LABA therapy had significantly improved lung function (ΔFEV1, LAMA/LABA 223.1 mL vs. LAMA 130.0 mL, ΔFEV1%pred, LAMA/LABA 10.8% vs. LAMA 6.8%; both p < 0.05). Postoperative complications were lower frequent in the LAMA/LABA group than in the LAMA group (p = 0.007). In patients with moderate to severe air flow limitation (n = 61), those who received LAMA/LABA therapy had significantly longer overall survival and disease-free survival compared with the LAMA (p = 0.049, p = 0.026) and rehabilitation-only groups (p = 0.001, p < 0.001). Perioperative LAMA/LABA therapy was also associated with lower recurrence rates (vs. LAMA p = 0.006, vs. rehabilitation-only p = 0.008).ConclusionsWe believe this treatment combination is optimal for patients with lung cancer and COPD.

Highlights

  • Chronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality

  • Patients who received long-acting muscarinic antagonist (LAMA)/Long-acting β2 agonist (LABA) therapy were significantly older than patients in the LAMA group (p = 0.045) and those in the No-BD group (p = 0.027)

  • There was no significant difference between patients in the LAMA/LABA group and the other groups with regard to sex, smoking status, pack-years of smoking or comorbidities, the type of surgical procedure performed, and histology there was a significant difference between the LAMA/LABA group and the LAMA group on pathologic staging

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Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is an important risk factor for postoperative complications and mortality. To determine the effects of perioperative combination therapy, using a long-acting muscarinic antagonist (LAMA) and a long-acting β2 agonist (LABA), on preoperative lung function, postoperative morbidity and mortality, and long-term outcome in COPD patients. Eligible patients with lung cancer receive a survival benefit from surgical resection, COPD is an important patient-related risk factor for postoperative complications and mortality [3]. It is important to alleviate peripheral airway obstruction and to reduce airway secretions to improve surgical outcomes [4,5,6]. The combination of smoking cessation, physical therapy, and the use of bronchodilators reportedly reduces postoperative complications and improves surgical outcomes in patients with lung cancer and COPD [7, 8]

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