Risk factors for postoperative complications Clavien-Dindo classification≥gradeⅡ after lung cancer surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIAO Xiaoqing ¹ ,  CHEN Zhang ¹ ,  DAI Wei ² , WEI Xing ² , PU Yang ³ , LIN Chao ¹ , FENG Wenhong ⁴ , ZHANG Yuanqiang ⁵ , MU Yunfei ⁶ , ZHANG Rui ⁷ , XIE Shaohua ² , WANG Xin ² , SHI Qiuling ^3,8 , LI Qiang ²

1. Department of Cardiothoracic Surgery, Dazhu County People's Hospital, Dazhou, 635100, Sichuan, P. R. China;
2. Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu, 610041, P. R. China;
3. School of Public Health and Management, Chongqing Medical University, Chongqing, 400016, P. R. China;
4. Department of Thoracic and Cardiovascular Surgery, Jiangyou People's Hospital, 621700, Sichuan, P. R. China;
5. Department of Cardiothoracic Surgery, Zigong First People's Hospital, Zigong, 643000, Sichuan, P. R. China;
6. Department of Thoracic Surgery, The Third People's Hospital of Chengdu, Chengdu, 610031, P. R. China;
7. Department of Thoracic Surgery, The Seventh People's Hospital of Chengdu, Chengdu, 610021, P. R. China;
8. Center for Cancer Prevention Research, Sichuan Cancer Hospital, Chengdu, 610041, P. R. China;

Corresponding?author：

CHEN Zhang, Email: 27418538@qq.com; DAI Wei, Email: daiwei@sichuancancer.org

Keywords：

Lung cancer; surgery; complications; Clavien-Dindo classification; risk factor

DOI：

10.7507/1007-4848.202111049

Video：

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Objective To investigate the risk factors for postoperative complications Clavien-Dindo classification≥grade Ⅱ after lung cancer surgery. Methods The patients who underwent lung cancer surgery in a multicenter observational study from November 2017 to January 2020 were included. The Clavien-Dindo classification of postoperative complications was analyzed. Logistic regression was used to identify the risk factors for complications≥ gradeⅡ. Results A total of 388 patients were enrolled, including 203 males and 185 females with a mean age of 56.14±10.36 years. The incidence of postoperative complications was 25.52% (99/388) after lung cancer surgery and the incidence of complications≥gradeⅡ was 20.10% (78/388). The five most common postoperative complications were pneumonia (6.96%), prolonged pulmonary air leak (>7 days, 5.67%), incision dehiscence (4.64%), arrhythmia (3.87%), and postoperative pleural effusion (3.35%). Multivariate analysis showed that open surgery [reference: uniportal thoracoscopic surgery, OR=2.18, 95%CI (1.01, 4.70), P=0.047], extended resection [reference: sublobar resection, OR=2.86, 95%CI (1.11, 7.19), P=0.030; reference: lobectomy, OR=2.20, 95%CI (1.10, 4.40), P=0.026] and operative time≥3 h [OR=2.07, 95%CI (1.12, 3.85), P=0.021] were independent risk factors for postoperative complications≥gradeⅡ after lung cancer surgery. Conclusion Surgical approach, extent of resection and operative time are independent influencing factors for postoperative complications≥gradeⅡ after lung cancer surgery.

Citation： LIAO Xiaoqing, CHEN Zhang, DAI Wei, WEI Xing, PU Yang, LIN Chao, FENG Wenhong, ZHANG Yuanqiang, MU Yunfei, ZHANG Rui, XIE Shaohua, WANG Xin, SHI Qiuling, LI Qiang. Risk factors for postoperative complications Clavien-Dindo classification≥gradeⅡ after lung cancer surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(8): 1151-1157. doi: 10.7507/1007-4848.202111049 Copy

1.	Chen F, Wang G. Enhanced recovery after surgery for lung cancer patients. Open Med (Wars), 2020, 15: 198-203.
2.	李鵬飛, 賴玉田, 周坤, 等. 應用Clavien-Dindo分級系統對肺癌患者術后并發癥分級及危險因素分析. 中國肺癌雜志, 2017, 20(4): 264-271.
3.	Fernandez FG, Falcoz PE, Kozower BD, et al. The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: Joint standardization of variable definitions and terminology. Ann Thorac Surg, 2015, 99(1): 368-376.
4.	中國醫師協會胸外科醫師分會, 胸外科專業術語標準化委員會. 胸外科疾病標準化診療術語. 北京: 人民衛生出版社, 2017. 81-106.
5.	Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
6.	岑磊磊. 結腸癌根治術后并發癥的Clavien-Dindo分級及其危險因素分析. 中國現代普通外科進展, 2021, 24(9): 706-710.
7.	王少東, 隋錫朝, 楊帆, 等. 早期非小細胞肺癌VATS根治術并發癥預測模型的建立—前瞻性多中心研究. 中華胸心血管外科雜志, 2017, 33(2): 87-90, 102.
8.	王政. 非小細胞肺癌肺葉切除術后并發癥分級及其危險因素分析. 蚌埠醫學院, 2020.
9.	聶蘊韜. 改良POSSUM評分聯合Clavien-Dindo分級預測胸腔鏡肺手術術后嚴重并發癥發生率的應用研究. 河北醫科大學, 2018.
10.	Dai W, Xie S, Zhang R, et al. Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients with lung cancer: A multicentre, prospective, observational cohort study protocol. BMJ Open, 2019, 9(10): e030726.
11.	Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis, 1987, 40(5): 373-383.
12.	Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status—Historical perspectives and modern developments. Anaesthesia, 2019, 74(3): 373-379.
13.	Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
14.	Sawada S, Suehisa H, Ueno T, et al. Changes in post-operative complication and mortality rates after lung cancer resection in the 20-year period 1995-2014. Acta Med Okayama, 2016, 70(3): 183-188.
15.	夏琰, 倪錚錚, 楊潔, 等. 胸腔鏡肺癌根治術術后并發癥及其嚴重程度的危險因素分析. 中華胸心血管外科雜志, 2013, 29(8): 487-490.
16.	Motono N, Ishikawa M, Iwai S, et al. Individualization of risk factors for postoperative complication after lung cancer surgery: A retrospective study. BMC Surg, 2021, 21(1): 311.
17.	Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
18.	Dai W, Dai Z, Wei X, et al. Early patient-reported outcomes after uniportal vs. multiportal thoracoscopic lobectomy. Ann Thorac Surg, 2021, S0003-4975(21): 01674-X.
19.	Wei X, Yu H, Dai W, et al. Patient-reported outcomes of video-assisted thoracoscopic surgery versus thoracotomy for locally advanced lung cancer: A longitudinal cohort study. Ann Surg Oncol, 2021, 28(13): 8358-8371.
20.	Dimitrovska NT, Bao F, Yuan P, et al. Learning curve for two-port video-assisted thoracoscopic surgery lung segmentectomy. Interact Cardiovasc Thorac Surg, 2022, 34(3): 402-407.
21.	Migliore M, Criscione A, Calvo D, et al. Safety of video-assisted thoracic surgery lobectomy for non-small-cell lung cancer in a low-volume unit. Future Oncol, 2016, 12(23s): 47-50.
22.	冀華遜. 非小細胞肺癌術后并發癥的危險因素分析. 轉化醫學電子雜志, 2015, 2(11): 68-69.
23.	Pennathur A, Brunelli A, Criner GJ, et al. Definition and assessment of high risk in patients considered for lobectomy for stage Ⅰ non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. J Thorac Cardiovasc Surg, 2021, 162(6): 1605-1618.
24.	Lugg ST, Agostini PJ, Tikka T, et al. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax, 2016, 71(2): 171-176.
25.	姜格寧, 張雷, 朱余明, 等. 肺切除手術患者術前肺功能評估肺科共識. 中國胸心血管外科臨床雜志, 2020, 27(1): 1-9.
26.	Zhang Y, Jheon S, Li H, et al. Results of low-dose computed tomography as a regular health examination among Chinese hospital employees. J Thorac Cardiovasc Surg, 2020, 160(3): 824-831.
27.	孫大強, 陳平雁, 劉倫旭, 等. 11958例Ⅰ~ⅢA期非小細胞肺癌手術患者不同隨訪方式5年生存率比較的多中心真實世界研究. 中國胸心血管外科臨床雜志, 2021, 28(6): 615-622.
28.	Pompili C, McLennan Battleday F, Chia WL, et al. Poor preoperative quality of life predicts prolonged hospital stay after VATS lobectomy for lung cancer. Eur J Cardiothorac Surg, 2021, 59(1): 116-121.

1. Chen F, Wang G. Enhanced recovery after surgery for lung cancer patients. Open Med (Wars), 2020, 15: 198-203.
2. 李鵬飛, 賴玉田, 周坤, 等. 應用Clavien-Dindo分級系統對肺癌患者術后并發癥分級及危險因素分析. 中國肺癌雜志, 2017, 20(4): 264-271.
3. Fernandez FG, Falcoz PE, Kozower BD, et al. The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: Joint standardization of variable definitions and terminology. Ann Thorac Surg, 2015, 99(1): 368-376.
4. 中國醫師協會胸外科醫師分會, 胸外科專業術語標準化委員會. 胸外科疾病標準化診療術語. 北京: 人民衛生出版社, 2017. 81-106.
5. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg, 2004, 240(2): 205-213.
6. 岑磊磊. 結腸癌根治術后并發癥的Clavien-Dindo分級及其危險因素分析. 中國現代普通外科進展, 2021, 24(9): 706-710.
7. 王少東, 隋錫朝, 楊帆, 等. 早期非小細胞肺癌VATS根治術并發癥預測模型的建立—前瞻性多中心研究. 中華胸心血管外科雜志, 2017, 33(2): 87-90, 102.
8. 王政. 非小細胞肺癌肺葉切除術后并發癥分級及其危險因素分析. 蚌埠醫學院, 2020.
9. 聶蘊韜. 改良POSSUM評分聯合Clavien-Dindo分級預測胸腔鏡肺手術術后嚴重并發癥發生率的應用研究. 河北醫科大學, 2018.
10. Dai W, Xie S, Zhang R, et al. Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients with lung cancer: A multicentre, prospective, observational cohort study protocol. BMJ Open, 2019, 9(10): e030726.
11. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis, 1987, 40(5): 373-383.
12. Mayhew D, Mendonca V, Murthy BVS. A review of ASA physical status—Historical perspectives and modern developments. Anaesthesia, 2019, 74(3): 373-379.
13. Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol, 2016, 11(1): 39-51.
14. Sawada S, Suehisa H, Ueno T, et al. Changes in post-operative complication and mortality rates after lung cancer resection in the 20-year period 1995-2014. Acta Med Okayama, 2016, 70(3): 183-188.
15. 夏琰, 倪錚錚, 楊潔, 等. 胸腔鏡肺癌根治術術后并發癥及其嚴重程度的危險因素分析. 中華胸心血管外科雜志, 2013, 29(8): 487-490.
16. Motono N, Ishikawa M, Iwai S, et al. Individualization of risk factors for postoperative complication after lung cancer surgery: A retrospective study. BMC Surg, 2021, 21(1): 311.
17. Suzuki K, Saji H, Aokage K, et al. Comparison of pulmonary segmentectomy and lobectomy: Safety results of a randomized trial. J Thorac Cardiovasc Surg, 2019, 158(3): 895-907.
18. Dai W, Dai Z, Wei X, et al. Early patient-reported outcomes after uniportal vs. multiportal thoracoscopic lobectomy. Ann Thorac Surg, 2021, S0003-4975(21): 01674-X.
19. Wei X, Yu H, Dai W, et al. Patient-reported outcomes of video-assisted thoracoscopic surgery versus thoracotomy for locally advanced lung cancer: A longitudinal cohort study. Ann Surg Oncol, 2021, 28(13): 8358-8371.
20. Dimitrovska NT, Bao F, Yuan P, et al. Learning curve for two-port video-assisted thoracoscopic surgery lung segmentectomy. Interact Cardiovasc Thorac Surg, 2022, 34(3): 402-407.
21. Migliore M, Criscione A, Calvo D, et al. Safety of video-assisted thoracic surgery lobectomy for non-small-cell lung cancer in a low-volume unit. Future Oncol, 2016, 12(23s): 47-50.
22. 冀華遜. 非小細胞肺癌術后并發癥的危險因素分析. 轉化醫學電子雜志, 2015, 2(11): 68-69.
23. Pennathur A, Brunelli A, Criner GJ, et al. Definition and assessment of high risk in patients considered for lobectomy for stage Ⅰ non-small cell lung cancer: The American Association for Thoracic Surgery expert panel consensus document. J Thorac Cardiovasc Surg, 2021, 162(6): 1605-1618.
24. Lugg ST, Agostini PJ, Tikka T, et al. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax, 2016, 71(2): 171-176.
25. 姜格寧, 張雷, 朱余明, 等. 肺切除手術患者術前肺功能評估肺科共識. 中國胸心血管外科臨床雜志, 2020, 27(1): 1-9.
26. Zhang Y, Jheon S, Li H, et al. Results of low-dose computed tomography as a regular health examination among Chinese hospital employees. J Thorac Cardiovasc Surg, 2020, 160(3): 824-831.
27. 孫大強, 陳平雁, 劉倫旭, 等. 11958例Ⅰ~ⅢA期非小細胞肺癌手術患者不同隨訪方式5年生存率比較的多中心真實世界研究. 中國胸心血管外科臨床雜志, 2021, 28(6): 615-622.
28. Pompili C, McLennan Battleday F, Chia WL, et al. Poor preoperative quality of life predicts prolonged hospital stay after VATS lobectomy for lung cancer. Eur J Cardiothorac Surg, 2021, 59(1): 116-121.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for postoperative complications Clavien-Dindo classification≥gradeⅡ after lung cancer surgery

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