Effect of Perioperative Bronchodilator Therapy on Postoperative Pulmonary Function among Lung Cancer Patients with chronic obstructive pulmonary disease

Sumin Shin1, Sun Hye Shin2, Yunjoo Im2, Genehee Lee3,4, Byeong-Ho Jeong2, Kyungjong Lee2, Sang-Won Um2, Hojoong Kim2, O Jung Kwon2, Jong Ho Cho1, Hong Kwan Kim1, Yong Soo Choi1, Jhingook Kim1, Jae Ill Zo1, Young Mog Shim1, Juhee Cho4,5,6, Danbee Kang4 and Hye Yun Park2

1Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea 3Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Korea 4Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea 5Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 6Department of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

Purpose : Chronic obstructive pulmonary disease (COPD), an established risk factor for lung cancer, remains largely undiagnosed and untreated before lung cancer surgery. We evaluated the effect of perioperative bronchodilator therapy on lung function changes in COPD patients who underwent surgery for non-small cell lung cancer (NSCLC).

Methods : Among NSCLC patients who underwent surgery, patients with spirometry-defined COPD were retrospectively identified. Perioperative bronchodilator therapy was defined as long-acting muscarinic antagonist and/or long-acting beta-2 agonist administration during the preoperative and postoperative period. Changes in forced expiratory volume in 1s (FEV1) were compared between patients treated with and without bronchodilators.

Results : Among 268 COPD patients, 112 (41.8%) received perioperative bronchodilator therapy, and 75% (84/112) were newly diagnosed with COPD before surgery. Declines in FEV1 after surgery were alleviated by perioperative bronchodilator therapy, after adjustments for surgical extent, thoracotomy, and preoperative FEV1 (adjusted mean difference in FEV1 decline [95% CI]; -161.1 mL [-240.2, -82.0]; -179.2 mL [-252.1, -106.3]; -128.8 mL [-193.2, -64.4] at 1, 4, and 12 months after surgery, respectively).

Conclusion : Perioperative bronchodilator therapy was effective to preserve lung function, particularly FEV1, after surgery for NSCLC in COPD patients. An active diagnosis and treatment of COPD are required for surgical candidates of NSCLC.

책임저자: Sumin Shin

Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

발표자: Sumin Shin, E-mail : essennee@gmail.com