Prediction of FEV1 and DLco in lung cancer patients undergoing lobectomy: Comparison between quantitative computed tomography, scintigraphy, and anatomy

Abstract

Introduction: Predicted postoperative (ppo) FEV₁ and DL_co must be estimated preoperatively prior to surgery for lung cancer. There are several methods to estimate the ppo values, but it is not still clear to which methods should we use.

Purpose and Methods: The aim of this study was to prospectively compare four techniques to estimate ppo values of FEV₁ and DL_co (%pred) after lobectomy: quantitative CT scans with low attenuation volume (LAV) of emphysematous lung parenchyma (CT_LAV), quantitative CT scans without LAV (CT), perfusion scans (Q), and an anatomical formula based on the number of segments (S). (Ethics # B13-110). FEV₁ and %DL_co were measured preoperatively and 3 months (3M) postoperatively in 57 patients underwent video-assisted thoracic surgery (VATS) lobectomy. Those FEV₁ and %DL_co were compared between ppo and 3M values using Spearman’s correlation coefficient according to the resected lobe. The mean volume difference between ppo and 3M are evaluated for each method.

Results: Lobectomy on right upper (RUL) and lower lobe (RLL) and left upper (LUL) and lower lobe (LLL) were 20, 14, 14 and 9 subjects, respectively. For both FEV₁ and %DL_co, 3M values were larger than ppo values, and difference between ppo and 3M values were small in estimated by 1) CTLAV for RLL, 2) Q for RUL and 3) S for LUL. In contrast, 4) ppo values estimated by all four technique were larger than 3M values for LLL. For RUL, ppo values estimated by S were also larger than 3M values.

Conclusion: We conclude that for single VATS lobectomy, adequate methods for estimating ppo values might be differ according to resected lobe.