Thoracic: Lung Cancer| Volume 164, ISSUE 2, P389-397.e7, August 2022

Postinduction therapy pulmonary function retesting is necessary before surgical resection for non–small cell lung cancer

Published:December 22, 2021DOI:



      Pretreatment-predicted postoperative diffusing capacity of the lung for carbon monoxide (DLCO) has been associated with operative mortality in patients who receive induction therapy for resectable non–small cell lung cancer (NSCLC). It is unknown whether a reduction in pulmonary function after induction therapy and before surgery affects the risk of morbidity or mortality. We sought to determine the relationship between induction therapy and perioperative outcomes as a function of postinduction pulmonary status in patients who underwent surgical resection for NSCLC.


      We retrospectively reviewed data for 1001 patients with pathologic stage I, II, or III NSCLC who received induction therapy before lung resection. Pulmonary function was defined according to American College of Surgeons Oncology Group major criteria: DLCO ≥50% = normal; DLCO <50% = impaired. Patients were categorized into 5 subgroups according to combined pre- and postinduction DLCO status: normal-normal, normal-impaired, impaired-normal, impaired-impaired, and preinduction only (without postinduction pulmonary function test measurements). Multivariable logistic regression was used to quantify the relationship between DLCO categories and dichotomous end points.


      In multivariable analysis, normal-impaired DLCO status was associated with an increased risk of respiratory complications (odds ratio, 2.29 [95% CI, 1.12-4.49]; P = .02) and in-hospital complications (odds ratio, 2.83 [95% CI, 1.55-5.26]; P < .001). Type of neoadjuvant therapy was not associated with an increased risk of complications, compared with conventional chemotherapy.


      Reduced postinduction DLCO might predict perioperative outcomes. The use of repeat pulmonary function testing might identify patients at higher risk of morbidity or mortality.

      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      ACCP (American College of Chest Physicians), ACOSOG (American College of Surgeons Oncology Group), ANCOVA (analysis of covariance), DLCO (diffusing capacity of the lung for carbon monoxide), FEV1 (forced expiratory volume in 1 second), ICI (immune checkpoint inhibitor), IQR (interquartile range), LOS (length of stay), NSCLC (non–small cell lung cancer), PFT (pulmonary function test), ppo (predicted postoperative)
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      • Commentary: Dum spiro spero
        The Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 2
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          Dum spiro spero is a Latin phrase that translates to, “while I breathe, I hope,” as the verb spiro means both “to breathe” and “to live.” Similarly, the Sanskrit and Hindi word prana, the Hebrew word ruach, and the Chinese word qi all represent a duality of breath and life. Despite clearly different etymological origins, these words communicate the idea of the literal and figurative association between breathing, hope, and life. However, the association between breathing, hope, and life are not just a theoretical concept.
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