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Influence of postoperative complications on long-term outcome after oncologic lung resection surgery. Substudy of a randomized control trial

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Abstract

Lung resection surgery (LRS) causes an intense local and systemic inflammatory response. There is a relationship between inflammation and postoperative complications (POCs). Also, it has been proposed that the inflammation and complications related with the surgery may promote the recurrence of cancer and therefore deterioration of survival. We investigated the association between inflammatory biomarkers, severity of POCs and long-term outcome in patients who were discharged after LRS. This is a prospective substudy of a randomized control trial. We established three groups based in the presence of POCs evaluated by Clavien-Dindo (C-D) classification: Patients with no postoperative complications (No-POCs group) (C-D = 0), patients who developed light POCs (L-POCs group) (C-D = I-II), and major POCs (M-POCs group) (C-D = III, IV, or V). Kaplan–Meier curves and Cox regression model were created to compare survival and oncologic recurrence in those groups. Patients who developed POCs (light or major) had an increase in some inflammatory biomarkers (TNF-α, IL-6, IL-7, IL-8) compared with No-POCs group. This pro-inflammatory status plays a fundamental role in the appearance of POCs and therefore in a shorter life expectancy. Individuals in the M-POCs group had a higher risk of death (HR = 3.59, 95% CI 1.69 to 7.63) compared to individuals in the No-POCs group (p = 0.001). Patients of L-POCs group showed better survival than M-POCs group (HR = 2.16, 95% CI 1.00 to 4.65, p = 0.049). Besides, M-POCs patients had higher risk of recurrence in the first 2 years, when compared with L-POCs (p = 0,008) or with No-POCs (p = 0.002). In patients who are discharged after undergoing oncologic LRS, there is an association between POCs occurrence and long term outcome. Oncologist should pay special attention in patients who develop POCs after LRS.

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Abbreviations

LRS:

Lung resection surgery

POCs:

Postoperative complications

No-POCs:

No postoperative complications

L-POCs:

Light postoperative complications

M-POCs:

Major postoperative complications

C-D:

Clavien Dindo classification

TNF:

Tumour necrosis factor

IL:

Interleukin

OLV:

One lung ventilation

TLV:

Two lung ventilation

Vt:

Tidal volume

BAL:

Bronchoalveolar lavage

VEGF:

Vascular endothelial growth factor

ICU:

Intensive care unit

ANOVA:

Analysis of variance

HR:

Hazard ratio

HIF:

Hypoxia inducible factor

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Authors and Affiliations

  1. Gregorio Maranon Hospital, Madrid, Spain

    Javier Casanova Barea, Francisco De la Gala, Patricia Piñeiro, Almudena Reyes, Carlos Simón, Jose María Bellón & Ignacio Garutti Martinez

  2. Medicine Faculty in Complutense University, Madrid, Spain

    Lisa Rancan, Elena Vara & Sergio Paredes

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  1. Javier Casanova Barea
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  2. Francisco De la Gala
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  3. Patricia Piñeiro
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Correspondence to Javier Casanova Barea.

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Casanova Barea, J., De la Gala, F., Piñeiro, P. et al. Influence of postoperative complications on long-term outcome after oncologic lung resection surgery. Substudy of a randomized control trial. J Clin Monit Comput 35, 1183–1192 (2021). https://doi.org/10.1007/s10877-020-00580-1

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