Ventilation defect burden predicts lung cancer resection outcomes

Background: Abnormal ventilation prior to lung cancer resection has not been investigated using modern ventilation imaging modalities and may better predict postoperative outcomes than guideline-recommended lung function tests. Our objective was to quantify the burden of ventilation defects observed using Technegas single-photon emission computed tomography (SPECT) and ¹²⁹Xe magnetic resonance imaging (MRI) before lung cancer resection, and to evaluate their association with postoperative pulmonary complications and length of hospital stay. Methods: This was a prospective, 6-week, observational study of adults undergoing lung cancer resection at a single centre. Before lung resection, participants underwent Technegas-SPECT, ¹²⁹Xe-MRI, spirometry and measurement of diffusing capacity of the lung for carbon monoxide. Preoperative ventilation defect burden was quantified by the Technegas-SPECT and ¹²⁹Xe-MRI ventilation defect percent (VDP). Predictors of complications during the 4-week postoperative period and length of hospital stay were evaluated by logistic and linear regression. Results: Abnormal ventilation was observed preoperatively by Technegas-SPECT and ¹²⁹Xe-MRI for 58% (60 of 103) and 73% (74 of 102) of participants, respectively. Preoperative VDPs were higher for participants with postoperative complications compared with those without (SPECT: p=0.01; MRI: p=0.0006) and correlated with length of hospital stay (SPECT: r=0.44, p<0.0001; MRI: r=0.51, p<0.0001). Multivariable models revealed preoperative VDP to be the strongest predictor of postoperative complications (SPECT: OR 1.06, 95% CI 1.01-1.11, p=0.02; MRI: OR 1.11, 95% CI 1.02-1.21, p=0.02) and length of hospital stay (SPECT: β=0.16, p<0.001; MRI: β=0.23, p<0.001). Conclusion: Abnormal ventilation is prevalent prior to lung cancer resection and may be a stronger predictor of postoperative complications and length of hospital stay than standard clinical lung function measures.