Abstract
BackgroundBroncho-pleural fistula (BPF) and respiratory failure (RF) are life-threatening complications after lung cancer surgery and can result in long-term hospitalization and decreased quality of life. Risk assessments for BPF and RF in addition to mortality and major morbidities are indispensable in surgical decision-making and perioperative care.MethodsThe characteristics and operative data of 80,095 patients who had undergone lung cancer surgery were derived from the 2014 and 2015 National Clinical Database (NCD) of Japan datasets. After excluding 1501 patients, risk models were developed from these data and validated by another dataset for 42,352 patients derived from the 2016 NCD dataset. Receiver operating characteristic curves were generated for postoperative BPF and RF development. The concordance-index was used to assess the discriminatory ability and validity of the model.ResultsBPF and RF occurred in 259 (0.3%) and 420 patients (0.5%), respectively, in the model development dataset and in 129 (0.3%) and 198 patients (0.5%), respectively, in the model validation dataset. Characteristic variables including types of surgery and comorbidities were identified as risk factors for BPF and RF, respectively. The concordance indexes of assessments for BPF and RF were 0.847 (p < 0.001) and 0.848 (p < 0.001), respectively, for the development dataset and 0.850 (p < 0.001) and 0.844 (p < 0.001), respectively, for the validation dataset.ConclusionsThese models are satisfactory for predicting BPF and RF after lung cancer surgery in Japan and could guide preoperative assessment and optimal measures for preventing BPF and RF.
Highlights
Lung cancer is a leading cause of death worldwide
Reoperation for the patients with Broncho-pleural fistula (BPF) was performed in 135 patients (52.1%) in the model development dataset and 65 patients (50.4%) in the model validation dataset
Several risk models and scoring systems derived by analyzing a big database have been developed and tested to improve stratification of mortality risk in lung cancer surgery [1,2,3]; a few studies have dealt only with BPF and/or respiratory failure (RF) risks [4,5,6]
Summary
Lung cancer is a leading cause of death worldwide. Surgery remains the mainstay for complete cure. Several risk models and scoring systems for improving stratification of mortality risk associated with lung cancer surgery have been developed and tested [1,2,3]. Broncho-pleural fistula (BPF) and respiratory failure (RF) are still major devastating postoperative complications after pulmonary resections for primary lung cancer even though. Extended author information available on the last page of the article their incidences have decreased over the last two decades Both are strongly associated with high mortality and negative impacts on activities of daily living following longterm hospitalization. Broncho-pleural fistula (BPF) and respiratory failure (RF) are life-threatening complications after lung cancer surgery and can result in long-term hospitalization and decreased quality of life. After excluding 1501 patients, risk models were developed from these data and validated by another dataset for 42,352 patients derived from the 2016 NCD dataset.
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