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Eur J Cardiothorac Surg 2005;27:732-733
© 2005 Elsevier Science NL

Letter to the Editor

Is lactate dehydrogenase level really a reliable predictor of pulmonary morbidity than other co-morbid parameters following lung resection for NSCLC?

Guven Olgaca,*, Aysun Olcmena, Cemal Asim Kutlub

a Department of Thoracic Surgery, Yedikule Hospital for Chest Diseases and Chest Surgery, Istanbul, Turkey
b Department of Thoracic Surgery, Vakif Gureba Hospital, Istanbul, Turkey

Received 10 November 2004; accepted 23 December 2004.

* Corresponding author. Address: Zuhuratbaba Mah. Turanli Sok., No. 4, D: 26, Bakirkoy 34147, Istanbul, Turkey. Tel.: +90 533 415 5434; fax: +90 212 547 2233. (E-mail: golgac{at}tnn.net).

Key Words: NSCLC • Lung resection • Morbidity • Lactate dehydrogenase

We have read with interest the article entitled ‘Lactate dehydrogenase (LDH) levels predict pulmonary morbidity after lung resection for non-small cell lung cancer’ by Turna et al. [1]. There have been a few studies addressing this interesting topic; however, one should consider its impact on the development of postoperative pulmonary complications very cautiously if an elevated LDH level was found to be the only independent predictor in the study. Despite current knowledge, its validity has not been confirmed in a prospective and randomized manner yet. In this regard, we have found several misquotations and some inaccurate inferences in their study which is not convincing for the reader, and clarification of these controversies is therefore needed.

Although title of the paper addresses postoperative ‘pulmonary’ morbidity, the nature of complications are ‘non-pulmonary’ in 25 patients (51% of all morbidity cases) in Table 1 of their article; thus, making all conclusions based on this data questionable in terms of pulmonary morbidity. Furthermore, we were unable to figure out the relevance between LDH level and some complications, such as hemorrhage and dysphonia, which are directly related to the technical errors during surgery [2]. Since there are a vast number of studies with larger series emphasizing the importance of preoperative evaluation of cardiopulmonary reserve in the literature [3,4], their statement of "controversy regarding the usefulness of the exercise capacity and ventilatory reserve tests" is unacceptable in the era of modern thoracic surgery today. In addition, this statement was extracted from two studies of which one contains 22 patients only and the other is 30-years-old.

From the study design point of view; calculation method for the ‘cut-off’ value of LDH level was not defined and is therefore unclear for the reader. Moreover, considering very favorable patient characteristics regarding age, oxygen saturation, FEV1, VC, arterial pCO2 and pO2 levels, their study group does not seem to represent a typical resected NSCLC population [2,3]. It is also difficult to understand why patients who received neoadjuvant therapy were excluded from the study since its undesirable influence on postoperative pulmonary morbidity is well-known [2]. On the other hand, it would have also been nice to know the power of the logistic regression analysis that was utilized based on a sample size of 108 with 19 independent variables. These conflicting subjects and questionable study design [5] make the data of this study highly precarious.

Finally, we would not agree with their suggestion to prolong the intensive care unit (ICU) stay—regardless of other parameters—for additional one day in patients with higher LDH levels, because no relevant information was provided to support this conclusion. Besides, some of major pulmonary complications occur unexpectedly and rather result in re-admission to ICU, while most of others (prolonged air leak, empyema, etc.) do not require intensive care management at all.

In conclusion, an LDH level cannot be considered as a reliable predictor of pulmonary morbidity with the presented data and statistical method until it is validity is confirmed with well-designed prospective and randomized studies.

References

  1. Turna A, Solak O, Çetinkaya E, Kiliçgün A, Metin M, Sayar A, Gürses A. Lactate dehydrogenase levels predict pulmonary morbidity after lung resection for non-small cell lung cancer. Eur J Cardiothorac Surg 2004;26:483-487.[Abstract/Free Full Text]
  2. Ginsberg RJ. Lung cancer surgery: acceptable morbidity and mortality, expected results and quality control. Surg Oncol 2002;11(4):263-266.[CrossRef][Medline]
  3. Myrdal G, Gustafsson G, Lambe M, Hörte LG, Ståhle E. Outcome after lung cancer surgery. Factors predicting early mortality and major morbidity. Eur J Cardiothorac Surg 2001;20(4):694-699.[Abstract/Free Full Text]
  4. Reilly JJ. Evidence-based preoperative evaluation of candidates for thoracotomy. Chest 1999;116(6):474S-476S.[Abstract/Free Full Text]
  5. Clark RE. Calculating risk and outcome: the society of thoracic surgeons database. Ann Thorac Surg. 1996;62(5):S2-5discussion S31-2.




This Article
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Right arrow Author home page(s):
Aysun Olcmen
Cemal Asim Kutlu
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Right arrow Articles by Olgac, G.
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Right arrow Lung - cancer
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