Akın KAYA, Cansel ATİNKAYA, Hakan KUTLAY, Hadi AKAY, Eriş Banu GÜLBAY, Gülseren KARABIYIKOĞLU, Öznur AKKOCA

Akciğer rezeksiyonu yapılacak hastaların fonksiyonel değerlendirmesi için egzersiz testinin önemi

Akciğer rezeksiyonü yapılacak hastaların preoperatif kardiyopulmoner rezervinin değerlendirilmesinde çok sayıda fizyolojik test bulunmasına rağmen, postoperatif pulmoner komplikasyon gelişimini tahmin etmede altın standart olan tek bir ölçüm bulunmamaktadır. Bu çalışmada; egzersiz testinin preoperatif kardiyopulmoner rezervin değerlendirilmesindeki önemi araştırıldı. Çalışmaya rezektabl bir akciğer hastalığı olan 26 hasta alındı [ortalama yaş: 51.5 ± 15.8 (13-78 yıl), 26 erkek; 22 küçük hücreli dışı akciğer kanseri, iki bronşektazi, bir kist hidatik, bir ampiyem]. Hastalar preoperatif solunum fonksiyon testleri (SFT), difüzyon kapasitesi (DLCO)'ve semptom sınırlı bisiklet testi ile prospektif olarak değerlendirildi. Fonksiyonel değerlendirme sonrası, hastaların tümüne standart torakotomi ile pulmoner rezeksiyon (beş pnömonektomi, 12 lobektomi, dört "wedge" rezeksiyon, iki nodül eksizyonu, bir kistotomi, bir eksploratris torakotomi, bir dekortikasyon) yapıldı. Hastaların postoperatif yoğun bakım ünitesi (YBÜ)'nde ortalama kalış süresi 2.6 gün, hastanede ortalama kalış süresi 11.9 ± 8 gün idi. Dokuz hastada postoperatif (30 gün içinde) takipte komplikasyon geliştiği görüldü. Bu hastalardan biri postoperatif dokuzuncu günde eksitus oldu. Komplikasyon uarlığı ile fizyolojik parametreler (SFT, DLCO) arasında bir ilişki gösterilemedi. Tüm hastalar; pik (zirve) oksijen tüketimi/kg (VC>2/kg peak) değerine göre üç gruba ayrıldı (< 10, 10-20, > 20 mL/kg/dakika). Bu gruplar arasında, komplikasyon gelişme açısından farklılık yoktu (p= 0.056). Ancak VC>2/kg peak değeri < 10 mL/kg/dakika olan grupta komplikasyon oranı daha yüksekti (%75). Öte yandan sadece pulmoner komplikasyon varlığı ile Vo2/kg peak arasında anlamlı bir ilişki tespit edildi (p= 0.034). Sonuç olarak; akciğer rezeksiyonu öncesinde preoperatif fonksiyonel değerlendirmenin, postoperatif mortalite ve morbiditeyi azaltmada önemli olduğunu ue özellikle de majör bir komplikasyon olarak değerlendirilebilecek pulmoner komplikasyon gelişimini tahmin etmede, kardi-yopulmoner egzersiz testinin önemli bir rol oynadığını düşünüyoruz.

The importance of exercise testing for the functional assessment of lung resectional candidates

Although there are a lot of physiologic tests to evaluate the preoperative cardio-pulmonary reserve in the patients who candidate lung resection, there is no a single gold standard test to suggest the postoperative pulmonary complicationse.In this study, we researched the importance of the exercise testing in the eualuation preoperatiue cardio-pulmonary reserve. We analyzed a series of 26 consecutive patients with a resectable lung disease [26 male patients, mean age 51.5 ± 15.8 (13-78 years), 22 non-small cell lung carcinoma (NSCLC), 2 bronchectasls, 1 hydatid cyst, 1 empyema]. Patients were evaluated by pulmonary function testing (PFT), diffusing capacity of lung for carbonmonoxide (DLCO), and symptom-limited exercise testing. After the functional examination, 26 patients underwent pulmonary resections with standard thoracotomy: 4 segmental or wedge resection, 11 lobectomies, 5 pneumonectomies, and 1 cystotomia. The mean stay in the ICU was 2.6 days (± 3.5), the mean hospital stay was 11.9 days (± 8.0). Postoperative complications (within 30 days) occurred in 9 (34.6%) patients of whom one died (overall mortality rate was 3.8%). There was no relationship between the presence of complication and physiologic tests (PFT, DLCO). The patients were divided three groups according to peak oxygen consumption (VOg/kg peak) (mL/kg/min) (< 10, 10-20, > 20 mL/kg/min). There was no significantly difference among these groups and complication rates (p= 0.056), but the complication rate was higher in the group of VO2/kg peak < 10 mL/kg/min (75%). On the other hand, there was a significantly relationship between the presence of only pulmonary complication and VU2/kg peak (p= 0.034). Conclusion; we think that the preoperative functional evaluation in the patients with lung resection candidate is prominent to reduce the postoperative mortality and morbidity and especially cardiopulmonary exercise testing has an important role to suggest the postoperative pulmonary complications as a major complication.

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