Early lung cancer surgery outcomes in chronic obstructive pulmonary disease

Background: This study evaluated 30-day outcomes after lobectomy for non-small cell lung cancer in patients with chronic obstructive pulmonary disease and explored factors associated with postoperative complications. Methods: A prospective case series included 65 patients. Outcomes through postoperative day 30 included surgical characteristics, length of stay, acute exacerbation of chronic obstructive pulmonary disease, pneumonia, prolonged air leak lasting more than five days, complication severity according to the Clavien-Dindo classification, and mortality. Associated factors were explored using univariable analyses. Results: Video-assisted thoracic surgery was used in 93.8% of patients and microscopically complete resection was achieved in 95.4%. At least one complication occurred in 37 of 65 patients (56.9%). Acute exacerbation of chronic obstructive pulmonary disease was most frequent (36.9%); pneumonia and prolonged air leak each occurred in 10.8%. Grade II and IIIa complications occurred in 46.2% and 10.8%, respectively; no grade IIIb or higher complication or 30-day death was observed. Preoperative pulmonary rehabilitation was associated with fewer postoperative exacerbations (odds ratio 0.25; 95% confidence interval 0.06-0.97), while body mass index below 18.5 kg/m² was associated with prolonged air leak (odds ratio 9.00; 95% confidence interval 1.03-78.58). Conclusions: In selected patients, lobectomy was predominantly performed by a minimally invasive approach with no 30-day mortality. Respiratory morbidity remained common. The observed associations are exploratory and require confirmation in larger studies.