Pulmonary Artery Hypertension Incidence in the Postoperative Course in Lung Cancer Surgery and the Influence of Pulmonary Artery Hypertension on the Postoperative Course and Long-term Survival

Abstract

Objectives: Pulmonary artery hypertension (PAH) is one of the serious complications of advanced lung cancer, as well as lung cancer surgical therapy. PAH is also related to high morbidity and mortality in postoperative lung cancer survivors. This study aims to determine the postoperative incidence of PAH in lung cancer surgery in stage II & III lung cancer patients, and the influence of PAH on the postoperative course and long-term survival. Methods: A retrospective cohort study included 241 lung cancer patients who underwent curative resection for non-small cell lung cancer NSCLC (stage II, III) at Giessen Lung Cancer Centre in Hessen Germany between 2010 and 2019. Pulmonary artery diameter/Aorta diameter (PA/A) ratio derived from chest computed tomography (CT) scan was used as a predictor for pulmonary hypertension before and after lung surgery. Techniques, complications, Long-term survival and outcomes were analyzed using IBM SSPS. Results: Mean PA & A diameters and PA/A ratio were 27.2 mm, 34.1 mm and 0.81 respectively. Postoperative PAH incidence at 6, 12, 18 months was 5.9%, 9.4%, and 15% respectively. Complications after lung resection occurred in 117 (48.5%) patients; respiratory complications were the most common. However, patients with postoperative atrial fibrillation were at a high risk to develop PAH in each follow-up (p<0.01), mostly at 18 months (odds ratio, 9.9; 95% CI, 2.5 to 295; p= 0.006). Mean hospitalization period in patients with postoperative PAH at 6, 12, 18 months was 12.6, 14.8, and 12.6 days respectively, mean survival years for those patients was (2.6 ± 2.79), (3.2 ± 3.05), (4.3 ± 2.94) respectively (p>0.05). Mortality was related to pulmonary comorbidities with a detected 118-fold risk for those patients (p=0.02), complicated cases were also at a higher risk for death compared to patients without postoperative complications (non-adjusted hazard ratio, 2.1; 95% CI, 1.2 to 3.5; p=0.006). Pulmonary artery hypertension as a predictor of death was of weak sensitivity and specificity (< 70%). Conclusion: Pulmonary artery hypertension is one of the possible lung cancer comorbidities. However, new onset PAH after lung resection is often detected, with tendency to occur late. Therefore, investigations for increased pulmonary artery pressure should -at least- continue for 18 months after surgery. Atrial fibrillation in particular should arise suspicion for PAH.