Analysis of Factors Affecting Prolonged Air Leak and Expansion Failure in the Lung after Resection in Patients with Pulmonary Malignancy and Predictive Value of Preoperative Quantitative Chest Computed Tomography

Abstract

Background The factors affecting the prolonged air leak (PAL) and expansion failure in the lung in patients undergoing resection for lung malignancy were analyzed. In this context, the value of the percentage of low attenuation area (LAA%) measured on preoperative quantitative chest computed tomography (Q-CT) in predicting the development of postoperative PAL and the expansion time of the remaining lung (ET) in patients undergoing resection for lung malignancy was investigated.

Methods The data of 202 cases who underwent lung resection between July 2020 and December 2022 were analyzed. The factors affecting the development of PAL and ET were investigated using univariate and multivariate analyses. The cut-off value for LAA% was determined and its relationship with postoperative results was examined.

Results In univariate analyses, for PAL, age (p = 0.022), presence of chronic obstructive pulmonary disease (COPD; p < 0.001), body mass index (BMI; p = 0.006), FEV₁ (p = 0.020), FEV₁/FVC (p < 0.001), LAA% (p = 0.008), diagnosis (p = 0.007), and surgical procedure (p < 0.001); for ET, diagnosis (p < 0.001) and surgical procedure (p = 0.001) were significant factors. A negative correlation between ET and BMI and FEV₁/FVC (p < 0.01) and a positive correlation (p < 0.05) was detected with LAA%. The cut-off value for LAA% was calculated as 1.065. Multivariate analyses showed that the probability of developing PAL, increased 3.17-, 7.68-, and 3.08-fold in patients with COPD, lobectomy, and those above the cut-off value for LAA%, respectively (p = 0.045, p < 0.001, and p = 0.011). In addition, FEV₁/FVC (p = 0.027), BMI (p = 0.016), and surgical procedure (p = 0.001) were shown to be independent factors affecting ET.

Conclusion Our study revealed the factors affecting PAL and expansion failure in the lung. Within this scope, it was concluded that preoperative Q-CT may have an important role in predicting the development of PAL and ET in the postoperative period and that LAA% measurement is an effective, objective, and practical method for taking precautions against possible complications.

Keywords

lung - malignancy - resection - quantitative - computed tomography

Author's Contributions

G.K.O.: designed the research, conceptualization, collecting and processing data, and writing the paper. H.Y.: conceptualization, collecting data, and writing the paper. A.Ç.: designed the research, conceptualization, collecting data, supervision, and writing—review and editing. K.D.: processing data, statistical analysis, and visualization. A.G.E.: collecting data, supervision, and writing—review and editing. T.İ.A.: collecting data, supervision, and writing—review and editing. A.Ö.: collecting data, supervision, and writing—review and editing. S.B.: data collection and measurement. K.T.: collecting data, supervision, and writing—review and editing. U.Ç.: collecting data, supervision, and writing—review and editing.

Ethical Approval Statement

The procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national) and the Declaration of Helsinki. Written or verbal informed consent was obtained from patients included in the study.

Publication History

Received: 20 July 2024

Accepted: 27 December 2024

Article published online:
21 January 2025

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