Analysis of risk factors for postoperative complications after uniportal-VATS lobectomy or segmentectomy in elderly patients with lung cancer

Abstract

Objective  To explore the risk factors of postoperative complications after uniportal-video-assisted thoracic surgery(VATS) lobectomy or segmentectomy in elderly patients with lung cancer. Methods  Lung cancer patients aged 60 years or older who underwent radical lobectomy or segmentectomy by uniportal-VATS from January 2020 to December 2021 were retrospectively studied. Preoperative and postoperative clinical data,including age,gender,smoking index,preoperative comorbidities,respiratory function,Charlson Comorbidity Index,surgical procedure,operation time et al.were collected.Univariate and multivariate Logistic regression were used to analyze risk factors.  Results  A total of 387 patients,comprising 171 (44.2%) male and 216 (55.8%) female were enrolled. The median age was 67 (range 60-87)years. Postoperative complications were observed in 66 (17.1%) patients; postoperative mortalities occurred in 1(0.3%) patient. Univariate and multivariate analyses showed that male (P=0.020),forced expiratory volume in the first second(FEV1)<1.5L(P=0.017),diffusion capacity of the lungs for carbon monoxide as a percentage of the predicted value(DLCO%pred)<80%(P=0.016),preoperative pulmonary comorbidities(P<0.001),preoperative stroke(P<0.001) and operation time≥3 h(P=0.018) were associated with postoperative complications. And preoperative pulmonary comorbidities(P<0.001) and operation time≥3 h(P=0.002)were associated with postoperative pulmonary complications. Conclusion  Elderly patients with lung cancer may have postoperative complications due to preoperative pulmonary comorbidities,poor lung function and longer operation time and so on. Therefore,the physiological status of elderly lung cancer patients should be fully evaluated preoperatively. By strengthening perioperative management,we may reduce the effect of postoperative complications on the treatment effect of uniportal-VATS surgery in elderly lung cancer patients.

Keywords

elderly / lung cancer / uniportal-assisted thoracic surgery(VATS) / postoperative complications / risk factors