Mete-analysis Of Complications In Lung Resection And Exercise Capascity

Objective:In recent years,with the application of high resolution CT and the advent of an aging society,more and more early lung cancer patients,which mostly with chronic obstructive pulmonary disease,need surgical lung resection.If these patients do not undergo surgery,eventually they will lose the chance of operation,resulting in greater medical and economic losses.VO₂max has been proposed to be the best predictor of postoperative cardiopulmonary complications（PPC）after surgical resection in lung cancer patients,the literature remains controversial.Exercise capacity,highest amount of oxygen a person can consume during maximal exercise of several minutes’duration.It was demonstrated by a leveling off or decline in oxygen consumption with increasing intensity.VO₂max is expressed either as an absolute rate in（for example）liters of oxygen per minute（L/min）or as a relative rate in（for example）milliliters of oxygen per kilogram of body mass per minute（e.g.mL/（kg·min））.The purpose of this study was to use the meta-analytic approach to determine if VO₂max,expressed as either mL/（g·min）or as a percentage of predicted,differed between patients who develop postoperative cardiopulmonary complications versus those that do not.Methods:Studies were retrieved via（1）computerized literature searches,（2）cross referencing from retrieved articles,and（3）expert review of our reference list.Trials were included if they reported preoperative VO₂max values（mL/（kg·min）or percentage of predicted）and had patients in which postoperative cardiopulmonary complications occurred.Results:Fourteen studies representing a total of 955 men and women met our criteria for inclusion.Across all designs and categories,random-effects modeling demonstrated that patients without postoperative pulmonary complications had significantly higher levels of VO₂max in mL/（kg·min）（mean difference=3.0,95%confidence interval（CI）,1.9-4.0）as well as VO₂max as a percentage of predicted（mean difference=8,95%CI,3.3-12.8）.Although the cardiopulmonary complications need attention in clinic,but in most cases,surgical treatment is still the best choice to cure the disease.Surgical treatment can consider the possibility to obtain long-term survival,most patients will still accept the serious complications.Through the analysis into the literature shows that different groups with different disease outcomes,effective the intervention can overcome the differences in prognosis,and improve the prognosis of patients.Conclusion:After a systematic review of the literature,we found that exercise capacity,expressed as VO₂max,is lower in patients that develop clinically relevant complications after curative lung resection.Since low levels of exercise tolerance can change is a potential risk factor,we can intervene to improve exercise tolerance level to reduce or eliminate postoperative cardiopulmonary complications.These results are important for the practicing clinician because they answer the literature controversy on the usefulness of measuring preoperative exercise capacity and reinforce the current guidelines on decision making for lung resection.