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J Thorac Cardiovasc Surg 1999;117:581-587
© 1999 Mosby, Inc.

GENERAL THORACIC SURGERY

DIFFUSING CAPACITY PREDICTS OPERATIVE MORTALITY BUT NOT LONG-TERM SURVIVAL AFTER RESECTION FOR LUNG CANCER

From the Section of Thoracic Surgery, Department of Surgery, The University of Chicago, Chicago, Ill.

Read at the Seventy-eighth Annual Meeting of The American Association for Thoracic Surgery, Boston, Mass, May 3-6, 1998.

Received for publication May 8, 1998. Revisions requested July 6, 1998. Revisions received Oct 28, 1998. Accepted for publication Oct 28, 1998. Address for reprints: Mark K. Ferguson, MD, 5841 S Maryland Ave, MC5035, Chicago, IL 60637.

Objectives: We sought to determine whether diffusing capacity influences operative mortality and long-term survival after resection for lung cancer.
Methods: We retrospectively reviewed the case histories of patients who underwent major resection for lung cancer. The association between operative mortality and predicted postoperative diffusing capacity was examined. Long-term survival among operative survivors was compared between the groups with high and low predicted postoperative diffusing capacity.
Results: The group comprised 410 patients with a mean age of 62.3 years. We performed 273 lobectomies, 35 bilobectomies, and 102 pneumonectomies. A total of 32 operative deaths (7.8%) were associated with low predicted postoperative diffusing capacity (P < .001). If we examine only operative survivors, there is no significant difference in survival data between patients with a predicted postoperative diffusing capacity of less than 50 and those with a predicted figure of 50 or more (stage I, 111 vs 90 months; stage II, 26 vs 32 months; stage IIIa 32 vs 26 months; log rank P > .5 for each). On the basis of the Cox proportional hazards model, predicted postoperative diffusing capacity did not have a statistically significant effect on long-term survival (estimated hazard ratio corresponding to a 20-point decrease in predicted postoperative diffusing capacity = 1.13; 95% confidence interval: 0.92 to 1.37).
Conclusion: A poor diffusing capacity is associated with high operative mortality but does not adversely affect long-term survival after major lung resection among operative survivors. Improving the perioperative management of patients undergoing major lung resection may enable inclusion of more patients with reduced diffusing capacity in the candidate pool for surgery, thus maximizing survival for early-stage lung cancer.

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