Lung cancer surgery for patients with reduced left ventricular ejection fraction: clinical outcomes and long-term survival

Abstract

OBJECTIVES The aim of the study was to evaluate the clinical outcomes of patients with lung cancer in whom left ventricular ejection fraction (LVEF) was reduced. METHODS A total of 9814 patients with lung cancer who underwent pulmonary resection from 2010 to 2018 were included for the study. Fifty-six (0.57%) patients had LVEFs <= 45% and we performed propensity score matching (1:3) to compare postoperative clinical outcomes and survival in 56 patients (reduced LVEF group) with those in 168 patients with normal LVEFs (nonreduced LVEF group). RESULTS The data of the reduced LVEF group and nonreduced group were matched and compared. The 30- (1.8%) and 90-day (7.1%) mortality rates were higher in the reduced LVEF group than those (0% for both 30- and 90-day mortality rates) in the nonreduced LVEF group (P < 0.001). The estimated rates of overall survival at 5-year point were similar in the nonreduced LVEF group (66.0%) and in the reduced LVEF group (60.1%). The estimated rates of overall survival at 5-year point were almost the same between in the nonreduced and reduced LVEF groups for clinical stage 1 lung cancer (76.8% vs 76.4%, respectively), but for stages 2 and 3, they were significantly better in the nonreduced LVEF group than in the reduced LVEF group (53.8% vs.39.8%, respectively). CONCLUSIONS Lung cancer surgery for selected patients with reduced LVEFs can yield favourable long-term outcomes despite the relatively high early mortality rate. A careful patient selection and meticulous postoperative care could further improve clinical outcome with reduced LVEF. Heart failure is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood [1] and is an acknowledged risk factor for comorbidity and lower survival rate after noncardiac surgery [2].