Impact of Goddard lung emphysema score on the duration of postoperative air-leakage in lung segmentectomy

Background Preoperative 3D evaluation of lung structure allows for quantifying lung emphysema calculating Goddard's Score and also surgery planning of lung segmentectomies. Segmentectomy becomes more and more important due to evidence of its oncological outcome, more lung tumour findings in screening, and elder patients. Postoperative air-leakage contributes to hospitalisation and morbidity. Thus, we aim to evaluate the impact of Goddard Score on postoperative air-leakage in lung segmentectomies.

Methods & Materials Patients presenting for VATS segmentectomy from January 2022 to June 2023 with a sufficient high-quality pre-operative CT-scan were retrospectively analysed with regards to postoperative air-leakage duration as primary endpoint. Secondary endpoints were the impact of further patients' characteristics like smoking habits, adhesiolysis, immunosuppression etc.

Results One hundred and thirty-one patients were analysed. The basic characteristics were: mean age 69±9 years, BMI 26±6kg/m², active smokers 27%, former smokers 56%, packyears 34±28, FEV1 80±18%, DLCO 61±17%, median Goddard-Score 1 [0;12]. 2% were pre-radiated, 8% pre-operated. Adhesiolysis was performed in 39%. A mean of 1.7 segments was removed. 40% of the operations were complex segment resections. The parenchyma was dissected with stapler only in 87%, partially with stapler in 10% and without stapler in 3%. Mean operative time was 146±53min, postoperative length of stay 7.5±4.2 days, air-leakage duration 4.1±5.0 days. 16% had a prolonged air-leak (more than 7 days). 6.1% of patients were discharged with an indwelled chest tube.

The Goddard-Score does not correlate with air-leakage duration (r=-0.04).

Significant predictors for prolonged fistula duration for more than 7 days were the need for adhesiolysis (OR=4.8 [1.3, 17.1], p=0.05), lower BMI (OR=0.7 [0.6, 0.8], p<0.01), immunosuppression (OR=7.1 [1.0, 51.2], p=0.05), packyears (OR 1.02 [1.00, 1.04], p=0.05), and longer surgery duration (OR=1.02 [1.00, 1.03], p<0.05; logistic regression). The AUC for these five items is 0.86, including Goddard-Score AUC increases to 0.94.

Conclusion The Goddard-Score alone does not predict prolonged air-leakage after segmentectomy. Although most patients were smokers with impaired diffusion capacity and visible lung emphysema, the calculated Goddard-Scores were relatively low. The combination of Goddard-Score and duration of surgery, packyears, BMI, immunosuppression, adhesiolysis, and complex segmentectomies accurately predicts prolonged air-leakage best.

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Artikel online veröffentlicht:
13. August 2024