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Eur J Cardiothorac Surg 2006;30:203
© 2006 Elsevier Science NL

Letter to the Editor

Reply to Pramesh and Mistry

Alessandro Brunelli a , * , Gaetano Rocco b

a Unit of Thoracic Surgery, "Umberto I" Regional Hospital Ancona, Via S. Margherita 23, Ancona 60129, Italy
b Division of Thoracic Surgery, National Cancer Institute, Pascale Foundation, Naples, Italy

Received 3 April 2006; accepted 5 April 2006.

* Corresponding author. Tel.: +39 0715964439; fax: +39 0715964433. (Email: alexit_2000{at}yahoo.com).

Key Words: Pulmonary function tests • Carbon monoxide lung diffusion capacity • Lung resection • Morbidity

We thank Drs Pramesh and Mistry [1] for their supportive comments on our recent article showing the poor correlation of FEV1 and DLCO and the ability of ppoDLCO to predict complications in patients with normal FEV1 [2].

We think our findings should warrant the systematic measurement of DLCO in all candidates for lung resection in order to refine risk stratification.

However, similarly as with ppoFEV1, ppoDLCO should not be used alone or in combination with ppoFEV1 to exclude patients from operation. We think these measures should be interpreted in combination with tests that assess the fitness of the entire oxygen transport system, such as cardiopulmonary exercise tests.

In the present era of managed care system and constrained resources, issues concerning costs and logistics at different thoracic institutions should also be considered. However, the costs to implement systematic DLCO measurement for lung resection candidates may be justified by the benefits in terms of risk stratification, which may also serve the purpose to plan postoperative advanced care management in those patients with prohibitive gas exchange capacity.

Finally, the systematic DLCO measurement will be essential for refining future population-based risk models, particularly those derived from international multi-institutional datasets. It was disappointing that only 25% of the patients voluntarily included in the European Thoracic Surgery Database by 27 different centers from 14 European countries had DLCO measured [3]. As a consequence of this low prevalence, ppoDLCO could not be used in the model building procedure.

It is our hope that future versions of the ESOS model will factor ppoDLCO.

Hopefully, our work will be instrumental to convince thoracic surgeons across Europe to measure lung diffusion capacity more liberally before lung resection.

References

  1. Pramesh CS, Mistry RC. Should carbon monoxide lung diffusion capacity (DLCO) measurement be mandatory before lung resection? Eur J Cardiothorac Surg 2006;30:199–203..
  2. Brunelli A, Refai MA, Salati M, Sabbatini A, Morgan-Hughes NJ, Rocco G. Carbon monoxide lung diffusion capacity improves risk stratification in patients without airflow limitation: evidence for systematic measurement before lung resection. Eur J Cardiothorac Surg 2006;29:567-570.[Abstract/Free Full Text]
  3. Berrisford RG, Brunelli A, Rocco G, Treasure T, Utley M. The European Thoracic Surgery Database project: modeling the risk of in-hospital death following lung resection. Eur J Cardiothorac Surg 2005;28:306-311.[Abstract/Free Full Text]




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