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Minerva Surgery 2021 May 28

DOI: 10.23736/S2724-5691.21.08717-7


language: English

Efficacy of preoperative inhaled LAMA/LABA combinations in patients with lung cancer and untreated COPD

Yoshimasa MIZUNO 1 , Koyo SHIRAHASHI 2, Hirotaka YAMAMOTO 2, Mitsuyoshi MATSUMOTO 2, Yusaku MIYAMOTO 2, Hiroyasu KOMURO 2, Kiyohiko HAGIWARA 2, Kiyoshi DOI 2, Hisashi IWATA 3

1 Department of General Thoracic Surgery, Chuno Kosei Hospital, Seki, Japan; 2 Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan; 3 Department of General Thoracic Surgery, Center of Respiratory Disease, Gifu University Hospital, Gifu, Japan


BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with a high incidence of postoperative pulmonary complications (PPCs). When untreated COPD is found before lung cancer surgery, we have been actively intervening therapeutically with inhaled long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) combinations. We investigated the efficacy of preoperative LAMA/LABA treatment.
METHODS: We reviewed data from 261 patients who underwent pulmonary resection for primary lung cancer. Of these, 59 patients showed unrecognized obstructive ventilatory impairment on respiratory function testing. We administered inhaled drugs for 38 patients, of whom 22 patients treated with LAMA/LABA combinations and diagnosed with COPD were retrospectively analyzed regarding improvement of respiratory function and postoperative course.
RESULTS: Median duration of LAMA/LABA treatment was 19.5 days (interquartile range (IQR), 10.5-28.3 days). Percentage predicted vital capacity (%VC) (pretreatment: 95.6%, IQR 91.9-111.7 vs posttreatment 102.8%, IQR 92.3-113.0), forced expiratory volume in 1 s (FEV1) (1.76 L, 1.43-2.12 vs 2.00 L, 1.78-2.40), forced VC (FVC) (2.96 L, 2.64-3.47 vs 3.22 L, 2.95-3.74) and percentage predicted FEV1 (80.1%, 68.4-97.0 vs 91.6%, 80.3-101.9) were all significantly improved (p < 0.05 each). FEV1/FVC tended to be improved, but not significantly. No significant difference in improvement of respiratory function was seen between short-term (≤2 weeks) and normal-term (>2 weeks) treatment. PPCs occurred in 4 of 22 patients (18.2%), showing no significant difference compared to patients with COPD previously treated with inhaled drugs (2/20; 10.0%).
CONCLUSIONS: Respiratory function is improved by preoperative LAMA/LABA treatment even in the short term. Starting treatment allows even COPD patients diagnosed on preoperative screening to experience the same frequency of PPCs as previously treated patients.

KEY WORDS: Lung cancer; Thoracic surgery; Chronic obstructive pulmonary disease; Bronchodilator agents; Drug combinations

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