EARLY AND LATE MORBIDITY IN PATIENTS UNDERGOING PULMONARY RESECTION WITH LOW DIFFUSION CAPACITY

Background. We sought to determine whether low diffiusion capacity of the lung to carbon monoxide (DLCO) is a predictor of high postoperativ e mortality and morbidity after major pulmonary resection and whether major pulmonary resection in patients with low DLCO results in substan tial long-term morbidity. Methods. Sixty-two major pulmonary resection s were performed in 61 patients with low DLCO (DLCO less than or equal to 60% predicted for pneumonectomy or bilobectomy; less than or equal to 50% predicted for lobectomy). Contemporaneously, 262 other patient s underwent 263 major pulmonary resections (group II). Long-term morbi dity was assessed in subsets of patients with low (n = 24) and high (n = 22; DLCO >60% predicted) DLCO. Results. The hospital mortality rate s were equivalent (4.8% low DLCO versus 4.9% group II), whereas respir atory complications were more frequent in patients with low DLCO (18% versus 9.5%; p = 0.05). In the subgroup analyses, patients with low DL CO had more hospitalizations for respiratory compromise and worse medi an dyspnea scores. Analysis of patients with substantial dyspnea revea led an association with extended pulmonary resection and postoperative radiation therapy in patients with low DLCO. Conclusions. Patients wi th low DLCO underwent major pulmonary resection with a low mortality r ate and an acceptable, but increased, respiratory complication rate. L ong-term respiratory morbidity was increased in patients with low DLCO ; however, the extent of pulmonary resection and the use of postoperat ive radiation therapy may have contributed to the development of dyspn ea in these patients.