Asthma is risk factor for complication after lung resection in older patients with non-small cell lung cancer associated with chronic obstructive pulmonary disease: a retrospective study

Asthma is risk factor for complication after lung resection in older patients with non-small cell lung cancer associated with chronic obstructive pulmonary disease: a retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Asthma is risk factor for complication after lung resection in older patients with non-small cell lung cancer associated with chronic obstructive pulmonary disease: a retrospective study Yoshihito Iijima, Takaki Mizoguchi, Masahito Ishikawa, Shun Iwai, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4945929/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The risk factors for postoperative complications in patients with chronic obstructive pulmonary disease (COPD) remain unclear. In this study, we aimed to identify the risk factors for postoperative pulmonary complications in older patients with lung cancer associated with COPD. Methods We retrospectively analyzed the data from 153 older patients who underwent pulmonary surgery for non-small-cell lung cancer associated with COPD between 2009 and 2018. Patients were categorized into two groups based on the presence or absence of Clavien–Dindo classification grade ≥ 2 pulmonary complications. We examined their clinicopathological characteristics and outcomes. Differences between the groups were assessed using univariate and multivariate analyses to identify risk factors. Results Pulmonary complications occurred in 42 (27.5%) patients. The group with postoperative complications had significantly longer durations of chest tube use and hospital stay than the group without complications. No perioperative or hospital deaths occurred within 1 or 3 months. Univariate analysis identified coexisting asthma, anemia (hemoglobin 220 min), pathological stage III, and fibrin glue use as risk factors for postoperative pulmonary complications. Multivariate analysis confirmed coexisting asthma and fibrin glue use as significant risk factors. Conclusions Asthma is a risk factor for postoperative pulmonary complications, particularly pneumonia, atelectasis, and sputum discharge disorder, and intraoperative fibrin glue use significantly reduced postoperative pulmonary complications, in our patient population. Surgical indications and postoperative care should be carefully considered in patients with asthma. older patients non-small cell lung cancer chronic obstructive pulmonary disease surgery postoperative complication Figures Figure 1 Background Postoperative pulmonary complications (PPCs) are one of the major causes of perioperative morbidity and mortality [ 1 ]. According to the 2006 guidelines from the American College of Physicians, advanced age and Chronic obstructive pulmonary disease (COPD) are two of the five well-documented patient-related risk factors for PPCs. Thoracic surgery is also among the 10 procedure-related factors of PPCs [ 2 ]. The risk of PPCs increased with age, with odds ratios of 3.90 (95% CI; 2.70–5.65) for individuals in their 70s and 5.63 (95% CI; 4.63–6.85) for those aged 80 years and older compared with those under 50 years of age [ 3 , 4 ]. COPD is an independent risk factor for lung cancer [ 5 – 7 ]. COPD is the most frequently cited risk factor for PPCs, with an odds ratio of 2.36 (95% CI; 1.90–2.93) for the occurrence of PPCs attributable to COPD [ 2 , 3 ]. The odds ratio for developing PPCs after thoracic surgery was notably high at 4.24 (95% CI; 2.89–6.23) [ 2 , 3 ]. Therefore, sufficient risk management of PPCs during surgery for COPD-related lung cancer, particularly in older patients, is essential. In Japan, the prevalence of COPD in patients aged ≥ 70 years is 24.4% [ 8 ]. The complication rate of lung cancer in COPD is reported to be approximately 9.1% [ 5 ]. Conversely, 50% of the patients with lung cancer are found to have COPD [ 9 ]. According to the Japanese Association for Thoracic Surgery annual reports, in 2018, patients aged ≥ 70 years accounted for 58.6% (26,305/44,859 patients) of all patients with lung cancer[ 10 ]. During surgical treatment of lung cancer, patients with COPD had a higher incidence of complications and poorer prognosis than those without COPD [ 11 ]. However, few reports have addressed the risk factors for postoperative complications in patients with COPD. In this study, we retrospectively investigated the risk factors for PPCs in older patients with lung cancer associated with COPD. Methods Ethical statement All procedures in this study were conducted in accordance with the ethical standards set by the Institutional Ethics Committee and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Kanazawa Medical University Institutional Ethics Committee granted approval for access to and use of patient data in April 2020 for this study (approval numbers: I160 and I449). Patients All clinical data were collected retrospectively. The study included patients aged ≥70 years who underwent surgery for non-small-cell lung cancer (NSCLC) associated with COPD between January 2009 and December 2018. Patients were divided into two groups based on the postoperative grade 2 or higher pulmonary complications evaluated using the Clavien–Dindo classification (CDC) [12]. The following variables were assessed: preoperative characteristics (age, sex, body mass index, Brinkman index, comorbidity, Charlson comorbidity index [CCI] [13], preoperative laboratory data, neutrophil-to-lymphocyte ratio [14], prognostic nutritional index [15], geriatric nutritional risk index [16], pulmonary function values, and COPD stage); surgical and pathological characteristics (surgical approach, procedure, nodal dissection, operation time, amount of bleeding, histology, pathological stage, and intraoperative findings [adhesion, bi-lobectomy or pneumonectomy or combined resection, intraoperative air leakage, blood vessel injury, thoracotomy conversion or re-thoracotomy, polyglycolic acid (PGA) sheet use, and fibrin glue use]); and perioperative morbidities (complications, morbidity, chest tube duration, postoperative hospital stay duration, and mortality). Tumors were classified and staged according to the Union for International Cancer Control tumor-node-metastasis classification for malignant tumors [17]. All surgeries were performed by the chief surgeon, with patient follow-up conducted on an outpatient basis. Surgical techniques included complete video-assisted thoracoscopic surgery (VATS) was performed thorough two ports with an incision of 5 cm or less, and hybrid VATS was performed with one or two ports through a 5–10-cm-wide incision. Systemic or lobe-specific lymph node dissection (LND) was performed in patients undergoing segmentectomy, lobectomy, bi-lobectomy, or pneumonectomy. Lymph node metastasis was determined using enhanced computed tomography (CT) and whole-body 2-deoxy-2-(18F)-fluorodeoxyglucose-positron emission tomography/CT imaging, with clinical staging applied for patients who underwent partial resection. Diagnosis of COPD Patients with coexisting COPD, who were not already treated for COPD by their primary care physician, were diagnosed based on the following criteria [18]: 1) history of exposure to risk factors such as long-term smoking; 2) post-bronchodilator spirometry result showing a forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) <70%, and 3) exclusion of other diseases that could cause airflow obstruction. Diagnosis of asthma Patients with coexisting asthma, other than those already treated for asthma by their primary care physician, were diagnosed based on the following criteria [1]: 1) relevant history of symptoms such as recurrent episodes of paroxysmal dyspnea, wheezing, chest tightness, or coughing; 2) evidence of variable airflow obstruction on spirometry, demonstrated by reversibility testing (improvement in FEV1 of 12% and at least 200 mL); and 3) presence of inflammatory biomarkers such as fractional exhaled nitric oxide (FeNO) (>25 ppm), blood eosinophils (≥300 cells/μL), and sputum eosinophils (≥3%). Classification of postoperative complications All complications occurring within the first 3 months following lung resection were recorded, with complications being defined as any deviation from the normal postoperative course. They were identified, quantified, and stratified according to the CDC. CDC The CDC categorizes postoperative complications based on objective data as follows [12]. Grade 1: Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic, or radiological interventions Allowed therapeutic regimens are antiemetics, antipyretics, analgesics, diuretics, electrolytes, and physiotherapy. This grade also includes wound infections opened at the bedside. Grade 2: Complications requiring pharmacological treatment with drugs beyond those allowed for grade 1; this includes blood transfusions and total parenteral nutrition. Grade 3: Complications requiring surgical, endoscopic, or radiological intervention. Grade 3a: Interventions not requiring general anesthesia such as bronchoscopic toileting, chest drainage tube insertion under local anesthesia, pleurodesis therapy, and home oxygen therapy. Grade 3b: Interventions requiring general anesthesia such as tracheostomy, fenestration, and reoperation. Grade 4: Life-threatening complications (including central nervous system complications) requiring intensive care unit management; mechanical ventilation, continuous hemodiafiltration, and other mechanical supports. Grade 4a: Single organ dysfunction. Grade 4b: Multiorgan dysfunction. Grade 5: Death of the patient. Statistical analyses Statistical analyses were conducted using JMP version 14.0 (SAS Institute Inc., Cary, North Carolina, USA). Missing data were imputed using the mean or median of the observed values. Two-category comparisons were performed using the chi-square test, Fisher’s exact test, Student’s t-test, and Mann–Whitney U test for quantitative data. We used a logistic regression model for univariate and multivariate analyses. Accordingly, significant predictors (p<0.05) in the univariate analysis were used in the multivariate analysis to calculate hazard ratios (HRs) within patient subsets; a p-value of <0.05 indicated statistical significance. Results A total of 802 patients with lung cancer underwent surgery during the study period. Of these, 797 had lung resection and 5 underwent biopsy or exploratory thoracotomy/thoracoscopy. Moreover, 405 (50.8%) patients were aged ≥70 years, and 169 (21.2%) had coexisting COPD. However, only 153 (19.2%) patients were included in this study; 16 patients were excluded because they had secondary primary lung cancers or were diagnosed with postoperative pathological stage IV cancer or small cell lung cancer. Grade 2 or higher PPCs were observed in 42 (27.5%) out of 153 patients ( Figure 1 ). Preoperative patient characteristics We analyzed data from 153 patients (129 men and 26 women) with a mean age of 76.2 (standard deviation [SD], 4.5; range, 70–90) years ( Table 1 ). The median Brinkman index was 1000 (interquartile range [IQR], 600–1620). Among the patients, 15 (9.8%), 7 (4.6%), 26 (17.0%), 15 (9.8%), 35 (22.9%), 52 (34.0%), and 17 (11.1%) patients had asthma, interstitial pneumonia, heart disease, arrhythmia, malignant tumors in other organs, diabetes mellitus, and cerebrovascular disease, respectively. The median CCI was 5 (IQR 4–6). Asthma comorbidities were significantly more common in the PPC group than in the non-PPC group (p=0.003). Furthermore, hemoglobin levels were significantly lower in the PPC group than in the non-PPC group (p=0.044). There were no significant differences in preoperative laboratory data, immunonutritional indices, and pulmonary function values. Table 1. Preoperative characteristics of patients Postoperative pulmonary complication p value Total (n=153) Grade ≥2 (n=42) Grade <2 (n=111) Age (years); mean (SD) 76.2 (4.5) 76.3 (4.9) 76.2 (4.3) 0.847 Male sex; no. (%) 129 (84.3) 33 (78.6) 96 (86.5) 0.230 Body mass index; median (IQR) 23.1 (21.2-25.4) 23.2 (20.5-25.8) 23.1 (21.3-25.3) 0.868 Brinkman index; median (IQR) 1000 (600-1620) 1040 (622.5-1675) 1000 (500-1600) 0.415 Comorbidity Asthma; no. (%) 15 (9.8) 9 (21.4) 6 (5.4) 0.003 Interstitial pneumonia; no. (%) 7 (4.6) 0 (0.0) 7 (6.3) 0.096 Heart disease; no. (%) 26 (17.0) 6 (14.3) 20 (18.0) 0.583 Arrythmia; no. (%) 15 (9.8) 4 (9.5) 11 (9.9) 0.943 Malignant neoplasms; no. (%) 35 (22.9) 9 (21.4) 26 (23.4) 0.793 Diabetes mellitus; no. (%) 52 (34.0) 14 (33.3) 38 (34.2) 0.916 Cerebrovascular disease; no. (%) 17 (11.1) 5 (11.9) 12 (10.8) 0.849 Charlson comorbidity index; median (IQR) 5 (4-6) 5 (4-6) 5 (4-6) 0.725 Preoperative laboratory data Hemoglobin (g/dL); mean (SD) 13.4 (1.5) 12.9 (1.8) 13.6 (1.4) 0.044 Leucocyte (/μL); mean (SD) 6109.2 (1885.7) 5946.7 (2086.7) 6170.6 (1810.2) 0.514 Lymphocyte (/μL); mean (SD) 1529.1 (515.4) 1459.3 (485.2) 1555.5 (526.1) 0.304 Natrium (mmol/L); mean (SD) 141.0 (2.5) 140.7 (2.7) 141.1 (2.5) 0.418 Albumin (g/dL); mean (SD) 4.0 (0.4) 3.9 (0.6) 4.0 (0.4) 0.274 Immunonutritional index Neutrophil to lymphocyte ratio; mean (SD) 2.8 (1.5) 2.8 (1.3) 2.7 (1.5) 0.844 Prognostic nutritional index; mean (SD) 47.7 (5.3) 46.7 (6.2) 48.1 (4.9) 0.143 Geriatric nutritional risk index; mean (SD) 102.8 (10.0) 102.0 (12.1) 103.1 (9.1) 0.541 Pulmonary function value SpO2 (%); median (IQR) 97 (96-97) 97 (96-97) 97 (96-97) 0.453 %VC (%); mean (SD) 102.7 (16.1) 105.7 (18.4) 101.6 (15.1) 0.168 %FVC (%); mean (SD) 101.2 (16.4) 103.8 (19.3) 100.2 (15.1) 0.220 FEV1 (mL); mean (SD) 1915.2 (463.3) 1864.0 (433.9) 1934.6 (474.4) 0.402 %FEV1 (%); mean (SD) 80.5 (18.0) 82.2 (22.6) 79.9 (16.0) 0.469 FEV1% (%); mean (SD) 60.5 (8.3) 59.6 (8.0) 60.8 (8.3) 0.395 COPD stage I; no. (%) 77 (50.3) 20 (47.6) 57 (51.4) 0.680 Categorical data are shown as numbers (%) and continuous data are shown mean (SD) or median (IQR). COPD: chronic obstructive lung disease, FEV1: forced vital capacity in 1 second, FVC: forced vital capacity, IQR: interquartile range, SD: standard deviation, SpO2: percutaneous oxygen saturation, VC: vital capacity. [Table 1] Surgical outcomes and perioperative and pathological characteristics of patients The surgical approaches used included complete VATS, hybrid VATS, and open thoracotomy in 38 (24.8%), 94 (61.4%), and 21 (13.7%) patients, respectively ( Table 2 ). The surgical procedures performed were, wedge resection; segmentectomy; lobectomy; and bi-lobectomy, pneumonectomy, and extended resection were performed in 48 (31.4%), 11 (7.2%), 71 (46.4%), and 23 (15.3%) patients, respectively. Accordingly, LND was performed in patients who underwent segmentectomy, lobectomy, or other procedures excluding wedge resection. Lymph node sampling, lobe-specific LND, and systemic LND were conducted in 32 (20.9%), 26 (17.0%), and 45 (29.4%) patients, respectively. The mean operation time and amount of bleeding were 176.3 (SD, 98.4) min and 101.6 (SD, 183.6) mL, respectively. Histological examination revealed adenocarcinoma, squamous cell carcinoma (Sq), and other malignancies in 96 (62.7%), 47 (30.7%), and 10 (6.5%) patients, respectively. Other malignancies included five large cell neuroendocrine carcinomas, three adenosquamous carcinomas, one pleomorphic carcinoma, and one typical carcinoid. Pathological staging indicated that 112 patients (73.2%) were in stages 0/I, 27 patients (17.6%) in stage II, and 13 patients (9.2%) in stage III. Thoracotomy was significantly more common (p = 0.002), and operation time was significantly longer (p = 0.006) in the PPC group than in the non-PPC group. In addition, Sq (p = 0.010) and stage III lung cancer (p = 0.010) were more prevalent in the PPC group than in the non-PPC group. There was no significant difference between the two groups in terms of intraoperative factors such as adhesion, surgical procedures (bi-lobectomy, pneumonectomy, or extended resection), intraoperative air leakage, blood vessel injury, thoracotomy conversion or re-thoracotomy, and PGA sheet use. However, the use of fibrin glue was significantly lower in the PPC group than in the non-PPC group (p = 0.023). Table 2. Intraoperative and postoperative characteristics of the patients Postoperative pulmonary complication p value Total (n=153) Grade ≥2 (n=42) Grade <2 (n=111) Approach; no. (%) Complete VATS 38 (24.8) 5 (11.9) 33 (29.7) 0.002 Hybrid VATS 94 (61.4) 25 (59.5) 69 (92.2) Thoracotomy 21 (13.7) 12 (28.6) 9 (8.1) Procedure; no. (%) Wedge resection 48 (31.4) 9 (21.4) 39 (35.1) 0.195 Segmentectomy 11 (7.2) 3 (7.1) 8 (7.2) Lobectomy 71 (46.4) 20 (47.6) 51 (46.0) Bilob/Pn/Ex 23 (15.3) 10 (23.8) 13 (11.7) Nodal dissection; no. (%) None 50 (32.7) 10 (23.8) 40 (36.0) 0.416 Sampling 32 (20.9) 11 (26.2) 21 (18.9) Lobe-specific 26 (17.0) 9 (21.4) 17 (15.3) Systemic 45 (29.4) 12 (28.6) 33 (29.7) Operation time (min); mean (SD) 176.3 (98.4) 215.5 (109.9) 161.5 (89.8) 0.006 Amount of bleeding (mL); mean (SD) 101.6 (183.6) 153.3 (270.9) 82.0 (133.6) 0.109 Histology; no. (%) Adenocarcinoma 96 (62.7) 24 (57.1) 72 (64.9) 0.010 Squamous cell carcinoma 47 (30.7) 18 (42.9) 29 (26.1) Other types 10 (6.5) 0 (0.0) 10 (9.0) Pathological stage; no. (%) 0, I 112 (73.2) 26 (61.9) 86 (77.5) 0.010 II 27 (17.6) 7 (16.7) 20 (18.0) III 13 (9.2) 9 (21.4) 5 (4.5) Intraoperative findings; no. (%) Adhesion 53 (34.6) 17 (40.5) 36 (32.4) 0.351 Bilob/Pn/Ex 23 (15.0) 10 (23.8) 13 (11.7) 0.062 Intraoperative leakage 60 (39.2) 21 (50.0) 39 (35.1) 0.093 Blood vessel injury 10 (6.5) 4 (9.5) 6 (5.4) 0.356 Thoracotomy conversion due to bleeding, Re-thoracotomy in the operating room 9 (5.9) 4 (9.5) 5 (4.5) 0.239 PGA sheet use 100 (65.4) 24 (57.1) 76 (68.4) 0.189 Fibrin glue use 135 (88.2) 33 (78.6) 102 (91.9) 0.023 Categorical data are shown as numbers (%) and continuous data are shown as mean (SD) or median (IQR). Bilob: bi-lobectomy, Ex: extended resection, IQR: interquartile range, PGA: polyglycoric acid, Pn: pneumonectomy, SD: standard deviation, VATS: video-assisted thoracic surgery. [Table 2] Postoperative morbidities and outcomes Table 3 summarizes the PPCs observed in this cohort, and Table 4 summarizes the morbidities during the perioperative period. PPCs of CDC grade 2 or higher occurred in 42 (27.5%) patients. CDC grades 4, 3, and 2 were observed in 2 (1.3%), 37 (25.5%), and 5 (3.3%) patient, respectively. Forty-six PPCs were observed in 42 patients. Pulmonary fistula, defined as pleurodesis (grade 3), was the most common pulmonary complication (n=25; 16.3%), and other complications included atelectasis and sputum discharge disorder (n=6; 3.9%), pneumonia (n=5; 3.3%), respiratory failure (n=4; 2.6%), asthma (n=2; 1.3%), contralateral pneumothorax (n=2; 1.3%), bronchopleural fistula (n=1; 0.7%), and acute exacerbation of interstitial pneumonia (n=1; 0.7%). Additionally, eight (5.2%) patients with non-pulmonary complications were observed. All-grade arrhythmias were observed in 29 (18.9 %) cases. The chest tube duration (p=0.002) and postoperative hospital duration (p=0.029) were significantly longer in the PPC group than in the non-PPC group. No perioperative deaths occurred within 1 month. Importantly, no hospital deaths occurred within 3 months. There were no deaths (CDC grade 5) at the 30-day or 90-day follow-up. Table 3 . Postoperative pulmonary complications observed in this cohort Grade 4 PPCs Pneumonia (mechanical ventilation) 2 (1.3) Grade 3 PPCs Pulmonary fistula 25 (16.3) Atelectasis, sputum discharge disorder 6 (3.9) Respiratory failure (HOT) 4 (2.6) Contralateral pneumothorax 2 (1.3) Bronchopleural fistula 1 (0.7) Pneumonia (bronchoscopic toileting) 1 (0.7) Grade 2 PPCs Pneumonia 2 (1.3) Asthma 2 (1.3) IPAE 1 (0.7) PPCs grade 3 or higher 36 (23.5) PPCs grade 2 or higher 42 (27.5) no. (% of total [n=153]). HOT: home oxygen therapy, IPAE: acute exacerbation of interstitial pneumonia, PPC: postoperative pulmonary complication. Table 4. Morbidities during the perioperative period Postoperative pulmonary complication p value Total (n=152) Grade ≥2 (n=41) Grade <2 (n=111) Chest tube duration (day); mean (SD) 2.9 (3.6) 5.1 (6.0) 2.1 (1.5) 0.002 Postoperative hospital duration (day); mean (SD) 17.1 (32.5) 32 (59.3) 11.4 (5.8) 0.029 30-day mortality; no. (%) 0 (0.0) 90-day mortality; no. (%) 0 (0.0) Non-postoperative pulmonary complications (Grade 3 or higher); no. (%) 8 (5.2) 3 (7.1) 5 (4.5) 0.526 Grade 4 non-PPCs Renal failure (CHDF) 1 (0.7) 1 (2.4) - Grade 3 non-PPCs Chylothorax 2 (1.3) - 2 (1.8) Pleural effusion 1 (0.7) 1 (2.4) - Postoperative bleeding 1 (0.7) - 1 (0.9) Arrythmia 1 (0.7) - 1 (0.9) Others 2 (1.3) 1 (2.4) 1 (0.9) Arrythmia (all grade); no. (%) 29 (18.9) 12 (28.6) 17 (15.3) 0.062 Categorical data are shown as numbers (%) and continuous data are shown as mean (SD). CHDF: continuous hemodiafiltration, PPC: postoperative pulmonary complication, SD: standard deviation. [Table 4] Univariate and multivariate analyses to identify risk factors Table 5 presents the results of univariate and multivariate analyses. Coexisting asthma (presence or absence), coexisting anemia (hemoglobin 220 min), histology (Sq or non-Sq), pathological stage (III or 0–II), and intraoperative use of fibrin glue (use or not use) were extracted from the chi-square test, Fisher’s exact test, Student’s t-test, and Mann–Whitney U test and used in univariate analysis. Univariate analysis revealed that coexisting asthma was associated with a significantly higher HR (HR, 4.772; 95% confidence interval [CI], 1.604–15.192; p = 0.005), other significant factors included coexisting anemia (HR, 2.765; 95% CI, 1.204–6.371; p = 0.017), thoracotomy approach (HR, 4.533; 95% CI, 1.757–12.117; p=0.002), operation time >220 min (HR, 3.034; 95% CI, 1.405–6.584; p=0.005), and pathological stage III disease (HR, 5.782; 95% CI, 1.865–19.958; p=0.002). Conversely, the use of fibrin glue (HR, 0.323; 95% CI, 0.119–0.883; p=0.028) significantly reduced the HR. Subsequently, significant risk factors (p220 min, pathological stage III, and the use of fibrin glue, were further evaluated in multivariate analysis. Multivariate analysis revealed that coexisting asthma significantly increased HR (HR, 3.602; 95% CI, 1.007–12.881; p = 0.049), and the use of fibrin glue significantly reduced HR (HR, 0.323; 95% CI, 0.105–0.992; p = 0.048). Table 5 . Univariate and multivariate analyses Univariate analysis Multivariate analysis HR 95% CI p-value HR 95% CI p-value Asthma + 4.772 1.604–15.192 0.005 3.602 1.007–12.881 0.049 Anemia Hb = 12.1 g/dL or less 2.765 1.204–6.321 0.017 2.057 0.837–5.056 0.116 Approach Thoracotomy 4.533 1.757–12.117 0.002 2.380 0.728–-7.779 0.151 Operation time 220 min or more 3.034 1.405–6.584 0.005 1.456 0.573–3.699 0.430 Histology Sq 2.004 0.858–4.618 0.107 Pathological stage III 5.782 1.865–19.958 0.002 2.272 0.550–9.384 0.257 Fibrin glue use + 0.323 0.119–0.883 0.028 0.323 0.105–0.992 0.048 95% CI; 95% confidence interval, Hb: Hemoglobin, HR; hazard ratio, Sq: squamous cell carcinoma. Impact of asthma and fibrin glue use on lung complications after lung resection The impact of coexisting asthma, identified as a risk factor for PPC, on adverse pulmonary outcomes was evaluated ( Table 6 ). PPCs of CDC grades 4, 3, and 2 were observed in 2 (13.3%), 7 (21.2%), and 1 (6.7%) patients, respectively. Ten PPCs were observed in 9 (60.0%) patients. Atelectasis and sputum discharge disorder were the most prevalent PPCs (n=45; 26.7%), followed by pulmonary fistula (n=3; 20.0%), pneumonia (n=2; 13.3%), and asthma (n=1; 6.7%). No significant differences were observed in chest tube and postoperative hospital duration between the patients with and without PPCs. Asthma comorbidity was significantly associated with PPCs (grade ≥2, p=0.003; grade ≥3, p=0.004). In particular, the frequencies of grade ≥3 pneumonia, atelectasis, and sputum discharge disorders were significantly higher in the asthma group than in the non-asthma group (p<0.001). In contrast, the group that used fibrin glue intraoperatively had significantly fewer PPCs than the group that did not (grade ≥2, p=0.023; grade ≥3, p=0.005). Among these, 11 CDC grade 3 PPCs were observed in 9 (50.0%) patients. The most common PPC was pulmonary fistula (n=5; 27.8%), followed by respiratory failure (n=2; 11.1%), atelectasis and sputum discharge disorder (n=1; 5.6%), pneumonia (n=1; 5.6%), contralateral pneumothorax (n=1; 5.6%), and bronchopleural fistula (n=1; 5.6%). The incidence of grade ≥3 pulmonary fistulas tended to be lower in the group that used fibrin glue than in the group that did not. However, no significant difference in the prevalence of individual PPCs or a consistent trend was observed between the two groups. In addition, the two groups showed no significant differences in chest tube and postoperative durations. Table 6. Impacts of asthma and fibrin glue on lung complications after lung resection Asthma p-value Total (n=153) With (n=15) Without (n=137) Postoperative pulmonary complication; no. (%) Grade 4 PPCs Pneumonia (mechanical ventilation) 2 (1.3) 2 (13.3) - Grade 3 PPCs Pulmonary fistula 25 (16.3) 3 (20.0) 22 (15.9) 0.694 Atelectasis, sputum discharge disorder 6 (3.9) 4 (26.7) 2 (1.5) Respiratory failure (HOT) 4 (2.6) - 4 (2.9) Contralateral pneumothorax 2 (1.3) - 2 (1.5) Bronchopleural fistula 1 (0.7) - 1 (0.7) Pneumonia (bronchoscopic toileting) 1 (0.7) - 1 (0.7) Grade 2 PPCs Pneumonia 2 (1.3) - 2 (1.5) Asthma 2 (1.3) 1 (6.7) 1 (0.7) IPAE 1 (0.7) - 1 (0.7) PPCs grade 3 or higher 36 (23.5) 8 (53.3) 28 (20.3) 0.004 PPCs grade 2 or higher 42 (27.5) 9 (60.0) 33 (23.9) 0.003 Pneumonia, atelectasis, sputum discharge disorder (Grade 3 or higher); no, (%) 9 (5.9) 6 (40.0) 3 (2.2) <0.001 Fibrin glue use; no. (%) 135 (88.2) 15 (100.0) 120 (87.0) 0.046 Intraoperative air leakage; no. (%) 60 (39.2) 6 (40.0) 54 (39.1) 0.948 Chest tube duration (day); mean (SD) 2.9 (3.6) 3.7 (4.0) 2.8 (3.6) 0.406 Postoperative hospital duration (day); mean (SD) 17.1 (32.5) 52.0 (95.1) 13.3 (10.0) 0.138 Fibrin glue p-value Total (n=153) Use (n=135) Not use (n=18) PPCs grade 3 or higher 36 (23.5) 27 (20.0) 9 (50.0) 0.005 PPCs grade 2 or higher 42 (27.5) 33 (24.4) 9 (50.0) 0.023 Pulmonary fistula (Grade 3 or higher) 25(16.3) 20 (14.9) 5 (27.8) 0.137 Pneumonia, atelectasis, sputum discharge disorder (Grade 3 or higher); no. (%) 9 (5.9) 7 (5.2) 2 (11.1) 0.360 Coexisting asthma; no. (%) 15 (9.9) 15 (11.1) 0 (0.0) 0.046 Intraoperative air leakage; no. (%) 60 (39.2) 58 (43.0) 2 (11.1) 0.005 Chest tube duration (day); mean (SD) 2.8 (3.5) 2.8 (2.6) 4.2 (7.9) 0.123 Postoperative hospital duration (day); mean (SD) 17.0 (32.6) 16.7 (33.9) 20.2 (20.0) 0.667 Categorical data are shown as numbers (%) and continuous data are shown as mean (SD). HOT: home oxygen therapy, IPAE: acute exacerbation of interstitial pneumonia, PPC: postoperative pulmonary complication, SD: standard deviation. [Table 6] Discussion In this study, we identified asthma as a risk factor for PPCs in COPD-associated lung cancer. Postoperative grade ≥3 complications, including pneumonia, atelectasis, and sputum discharge disorder were approximately 10 times more frequent in patients with asthma than in those without asthma. Distinguishing, asthma from COPD becomes increasingly difficult with age, and the prevalence of the asthma-COPD overlap phenotype in patients with COPD is approximately 21.4% (range 8.6–33%) [4]. While patients with well-controlled asthma are not considered at risk of PPCs [19], poor control increases the risk of bronchospasm [20, 21]. Therefore, sufficient attention to asthma control status and medical history is essential during preoperative assessments. In this study, 15 patients with asthma underwent inhaler therapy, and no asthma attack was reported within the 3 months before surgery. Among these patients, four received triple inhaler therapy with an inhaled corticosteroid (ICS), a long-acting β2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA); nine patients received dual inhaler therapy with an ICS and a LABA, one received LABA and LAMA dual inhaler therapy, and one patient received LABA single inhaler therapy. Despite good asthma control, the frequency of PPCs remained notably high. Asthma is typically associated with airway hyperresponsiveness and inflammation [22]. FeNO, an indicator of airway inflammation, is often elevated in chronic lung disease conditions such as asthma and asthma-COPD overlap [23]. Preoperative FeNO levels are significant predictors of surgical outcomes after lung resection [24] and abdominal surgery [25]. Although FeNO was not assessed in this study, its preoperative measurement may be important in predicting PPCs. Pulmonary surgery involves several anesthetic invasions, such as exposure to high concentrations of oxygen, isolated lung ventilation, positive pressure ventilation, and direct surgical intervention into the lung parenchyma and peripheral airways during surgery [26]. These invasions exacerbate airway secretions during chronic airway inflammation in asthma and COPD. Additionally, a postoperative decline in the FEV1 may cause sputum discharge disorder, atelectasis, and pneumonia [27]. The effectiveness of inhaled medication may be insufficient due to reduced intake caused by postoperative pain or inadiquate understanding of inhalation techniques in older patients [28]. Preventing of air leaks after lung resection for cancer is essential for successful early postoperative outcomes. In our department, fibrin glue and PGA sheets are actively used during surgery for the following reasons: 1) to prevent postoperative air leakage or reinforce fragile lungs in patients with COPD and 2) to cover and fix free pericardial fat to the bronchial stump to prevent bronchopleural fistula [29]. While fibrin glue use resulted in fewer PPCs as a composite outcome, we confirmed that the incidence rate of grade 3 pulmonary fistula was not significant. However, using fibrin glue during surgery to prevent air leakage reduced postoperative pulmonary fistula by approximately 50%. In the 60 cases where intraoperative air leakage was observed, the incidence of grade ≥3 pulmonary fistulas was 14 (24.1%) in the fibrin glue group, compared with 2 (100%) in the non-use group. Thus, the frequency of postoperative pulmonary fistula was significantly lower in the fibrin glue group than in the non-use group (p=0.017, data not shown). Although this study did not quantitatively evaluate air leakage, the use of fibrin glue was thought to contribute to the control of postoperative pulmonary fistulas. On the other hand, all 15 patients with asthma used fibrin glue. Six of the 15 cases (40%) developed complications such as pneumonia, atelectasis, and sputum discharge disorder. Although this study did not examine the patient's allergic backgrounds, there have been reports of eosinophilic pneumonia [30] and eosinophilic pleural effusion [31] associated with the use of fibrin glue during surgery. This raises the possibility that fibrin glue may induce pneumonia or increase airway secretions in patients with certain allergic predispositions. Limitations This study has some limitations that should not be overlooked. First, the analysis was based on a small sample size from a single institution. Patients over the age of 70 years with COPD accounted for only 19% of those who underwent surgery at our institution during the study period, introducing potential selection bias. Second, there may be inconsistencies in the diagnosis of asthma between patients’ primary care physicians and our hospital, and the study did not directly distinguish between well-or-poorly controlled asthma. Therefore, we will continue to study the postoperative effects of airway inflammation and hypersensitivity by modalities such as FeNO measurement on patients with NSCLC and rank them based on the severity of the illness. Further prospective large-scale studies are required to address this issue. Conclusions Asthma is a significant risk factor for PPCs in older patients with NSCLC associated with COPD. Surgical indications and postoperative care should be carefully considered in patients with asthma. Although intraoperative use of fibrin glue was found to reduce the risk of PPCs in the multivariate analysis, subsequent examinations did not definitively confirm its effectiveness in preventing complications. However, intraoperative use of fibrin glue for patients who experienced intraoperative air leakage was found to reduce the risk of PPCs, especially pulmonary fistula in older patients with NSCLC associated with COPD. Previous reports of fibrin glue-induced PPCs underscore the need to use it with caution. Abbreviations CCI, Charlson comorbidity index; CDC, Clavien–Dindo classification; CI, confidence interval; COPD, chronic obstructive pulmonary disorder; CT, computed tomography; FeNO, fractional exhaled nitric oxide; FEV1, forced expiratory volume in 1 s; HR, hazard ratio; ICS, inhaled corticosteroid; IQR, interquartile range; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; LND, lymph node dissection; NSCLC, non-small cell lung cancer; PGA, polyglycolic acid; PPCs, postoperative pulmonary complications; SD, standard deviation; Sq, squamous cell carcinoma; VATS, video-assisted thoracoscopic surgery Declarations Ethics approval and consent to participate All procedures in this study were conducted in accordance with the ethical standards set by the Institutional Ethics Committee and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Kanazawa Medical University Institutional Ethics Committee granted approval for access to and use of patient data in April 2020 (approval numbers: I160 and I449). Consent for publication Not applicable Competing interest The authors declare that they have no competing interests. Funding No funding was received for this study. Authors’ contributions YI conceptualized and conducted the study, and performed a literature search. TM, MI, SI, and AY supervised the manuscript preparation, and critically revised the manuscript. NM, and HU supervised the manuscript preparation and critically revised the manuscript. All authors have reviewed and approved the final manuscript. Acknowledgments We would like to express our gratitude to all the patients who participated in this study. References Louis R, Satia I, Ojanguren I, Schleich F, Bonini M, Tonia T, et al. European respiratory society guidelines for the diagnosis of asthma in adults. Eur Respir J. 2022; doi: 10.1183/13993003.01585-2021. Smetana GW. Postoperative pulmonary complications: an update on risk assessment and reduction. Cleve Clin J Med. 2009;76 Suppl 4:S60-5. doi: 10.3949/ccjm.76.s4.10. Smetana GW, Lawrence VA, Cornell JE; American College of Physicians. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144:581-95. doi: 10.7326/0003-4819-144-8-200604180-00009 Gibson PG, McDonald VM. Asthma-COPD overlap 2015: now we are six. Thorax. 2015;70:683-91. doi: 10.1136/thoraxjnl-2014-206740 Smith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulm Dis. 2014; 9:871-88. doi: 10.2147/COPD.S49621 Kiri VA, Soriano J, Visick G, Fabbri L. Recent trends in lung cancer and its association with COPD: an analysis using the UK GP research database. Prim Care Respir J. 2010;19:57-61. doi: 10.4104/pcrj.2009.00048 Rodríguez LA, Wallander MA, Martín-Merino E, Johansson S. Heart failure, myocardial infarction, lung cancer and death in COPD patients: a UK primary care study. Respir Med. 2010;104:1691-9. doi: 10.1016/j.rmed.2010.04.018 Fukuchi Y, Nishimura M, Ichinose M, Adachi M, Nagai A, Kuriyama T, et al. COPD in Japan: the Nippon COPD Epidemiology study. Respirology. 2004;9:458-65. doi: 10.1111/j.1440-1843.2004.00637.x Young RP, Hopkins RJ, Christmas T, Black PN, Metcalf P, Gamble GD. COPD prevalence is increased in lung cancer, independent of age, sex and smoking history. Eur Respir J. 2009;34:380-6. doi: 10.1183/09031936.00144208 Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery; Shimizu H, Okada M, Toh Y, Doki Y, Endo S, Fukuda H et al. Thoracic and cardiovascular surgeries in Japan during 2018 : Annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2021;69:179-212. doi: 10.1007/s11748-020-01460-w Sekine Y, Yamada Y, Chiyo M, Iwata T, Nakajima T, Yasufuku K et al . Association of chronic obstructive pulmonary disease and tumor recurrence in patients with stage IA lung cancer after complete resection. Ann Thorac Surg. 2007;84:946-50. doi: 10.1016/j.athoracsur.2007.04.038 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13. doi: 10.1097/01.sla.0000133083.54934.ae Charlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol. 2008;61:1234-40. doi: 10.1016/j.jclinepi.2008.01.006 Dusselier M, Deluche E, Delacourt N, Ballouhey J, Egenod T, Melloni B et al . Neutrophil-to-lymphocyte ratio evolution is an independent predictor of early progression of second-line nivolumab-treated patients with advanced non-small-cell lung cancers. PLoS One. 2019;14:e0219060. doi: 10.1371/journal.pone.0219060 Okada S, Shimada J, Kato D, Tsunezuka H, Teramukai S, Inoue M. Clinical significance of prognostic nutritional index after surgical treatment in lung cancer. Ann Thorac Surg. 2017; 104:296-302. doi: 10.1016/j.athoracsur.2017.01.085 Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I et al . Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82:777-83. doi: 10.1093/ajcn/82.4.777 James DB, Mary KG, Christian W. UICC TNM Classification of malignant tumors. 8th ed. Hoboken, NJ: Wiley-Blackwell; 2016. The Japanese Respiratory society. The JRS Guidelines for the management of chronic obstructive pulmonary disease 2022. Tokyo: Medical Review; 2022. (in Japanese) Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006;144:575-80. doi: 10.7326/0003-4819-144-8-200604180-00008 Warner DO, Warner MA, Barnes RD, Offord KP, Schroeder DR, Gray DT, et al. Perioperative respiratory complications in patients with asthma. Anesthesiology. 1996;85:460-7. doi: 10.1097/00000542-199609000-00003 Woods BD, Sladen RN. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth. 2009;103 Suppl 1: i57-65. doi: 10.1093/bja/aep271 Reddel HK, Bacharier LB, Bateman ED, Brightling CE, Brusselle GG, Buhl R, et al. Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes. Eur Respir J. 2022;59:2102730. doi: 10.1183/13993003.02730-2021 Niimi A, Matsumoto H, Mishima M. Eosinophilic airway disorders associated with chronic cough. Pulm Pharmacol Ther. 2009;22:114-20. doi: 10.1016/j.pupt.2008.12.001 Okamoto K, Hayashi K, Kaku R, Kawaguchi Y, Oshio Y, Hanaoka J. Impact of fractional exhaled nitric oxide on the outcomes of lung resection surgery: a prospective study. J Thorac Dis. 2020;12:2663-71. doi: 10.21037/jtd.2020.03.18 Pi X, Wang C, Li Y, Zheng J, Cui Y, Guo L et al . Preoperative FeNO as a screening indicator of pulmonary complications after abdominal surgery in patients over 60 years old. J Breath Res. 2015;9:036004. doi: 10.1088/1752-7155/9/3/036004 Güldner A, Kiss T, Serpa Neto A, Hemmes SN, Canet J, Spieth PM et al . Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology. 2015;123:692-713. doi: 10.1097/ALN.0000000000000754 Sawabata N, Nagayasu T, Kadota Y, Goto T, Horio H, Mori T et al . Risk assessment of lung resection for lung cancer according to pulmonary function: republication of systematic review and proposals by guideline committee of the Japanese association for chest surgery 2014. Gen Thorac Cardiovasc Surg. 2015;63:14-21. doi: 10.1007/s11748-014-0475-x Bozek A, Jarzab J. Adherence to asthma therapy in elderly patients. J Asthma. 2010;47:162-5. doi: 10.3109/02770900903497204 Uramoto H, Nakajima Y, Kinoshita H. Is the isolated pericardial fat pad sufficient to cover the bronchial stump and separate the pulmonary artery in order to prevent bronchopleural fistula in patients with lung cancer?. Anticancer Res. 2016;36:2385-9. Kawamoto N, Okita R, Hayashi M, Okada M, Ito K, Ikeda E, et al. Suspected fibrin glue-induced acute eosinophilic pneumonia after pulmonary resection: a case report. Thorac Cancer. 2021;12:2126-9. doi: 10.1111/1759-7714.14040 Kawamoto N, Okita R, Okada M, Ito K, Hirazawa K, Inokawa H. Fibrin glue-induced eosinophilic pleural effusion after pulmonary resection: a case report. Int J Surg Case Rep. 2021;85:106239. doi: 10.1016/j.ijscr.2021.106239 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4945929","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":345276120,"identity":"960ed872-ee04-446f-92dc-3cdffa948130","order_by":0,"name":"Yoshihito Iijima","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuklEQVRIiWNgGAWjYDAC+YcNBz5UwHg8ROlJPvhwxhnStKQlG3O2keSuhjNm0ozz7kTLNzA//MAgc4ewFoODPWbShdue5W44wGYswcDzjAgtzDxm0jO3Hc7dwMBgBvTLYSIc1gbUwjvncO78BvZvxGlhOMOWbMzbcDi34QAPkbYY3GAGBvIxoMMO8xRLJBDjF/kZjMCorAE6rL1944ePPUSEGAIwA3FizwFStIDBD9K1jIJRMApGwfAHAClEPOf9k7amAAAAAElFTkSuQmCC","orcid":"","institution":"Kanazawa Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yoshihito","middleName":"","lastName":"Iijima","suffix":""},{"id":345276121,"identity":"3fb8a28d-ff84-4743-979e-d7641dd4dbce","order_by":1,"name":"Takaki Mizoguchi","email":"","orcid":"","institution":"Kanazawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Takaki","middleName":"","lastName":"Mizoguchi","suffix":""},{"id":345276122,"identity":"3fbf03a1-73bc-4a97-b7de-b82aea5d6a78","order_by":2,"name":"Masahito Ishikawa","email":"","orcid":"","institution":"Kanazawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Masahito","middleName":"","lastName":"Ishikawa","suffix":""},{"id":345276123,"identity":"d34ea24c-7fce-445f-868d-82164efc4a7f","order_by":3,"name":"Shun Iwai","email":"","orcid":"","institution":"Kanazawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shun","middleName":"","lastName":"Iwai","suffix":""},{"id":345276124,"identity":"0dbff656-cb6b-483d-a6d2-3c5bf3728232","order_by":4,"name":"Nozomu Motono","email":"","orcid":"","institution":"Kanazawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Nozomu","middleName":"","lastName":"Motono","suffix":""},{"id":345276125,"identity":"087c77a8-2659-4061-9da7-a035859642fc","order_by":5,"name":"Hidetaka Uramoto","email":"","orcid":"","institution":"Kanazawa Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hidetaka","middleName":"","lastName":"Uramoto","suffix":""}],"badges":[],"createdAt":"2024-08-20 14:55:43","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4945929/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4945929/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":66792524,"identity":"7b692091-787c-4a36-8c58-b685425177c8","added_by":"auto","created_at":"2024-10-16 13:47:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":151843,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart for patient selection showing the inclusion and exclusion criteria used in this study.\u003c/p\u003e\n\u003cp\u003eCOPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 s; NSCLC, non-small cell lung cancer\u003c/p\u003e","description":"","filename":"Figure1300dpi.png","url":"https://assets-eu.researchsquare.com/files/rs-4945929/v1/7275e1bc10d3c36db0447aef.png"},{"id":82249183,"identity":"86454ce2-9568-4bfa-855d-476d88339fb5","added_by":"auto","created_at":"2025-05-08 09:39:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1127895,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4945929/v1/ffbc88bd-7391-4346-9f93-85aa3f003373.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Asthma is risk factor for complication after lung resection in older patients with non-small cell lung cancer associated with chronic obstructive pulmonary disease: a retrospective study","fulltext":[{"header":"Background","content":"\u003cp\u003ePostoperative pulmonary complications (PPCs) are one of the major causes of perioperative morbidity and mortality [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to the 2006 guidelines from the American College of Physicians, advanced age and Chronic obstructive pulmonary disease (COPD) are two of the five well-documented patient-related risk factors for PPCs. Thoracic surgery is also among the 10 procedure-related factors of PPCs [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The risk of PPCs increased with age, with odds ratios of 3.90 (95% CI; 2.70\u0026ndash;5.65) for individuals in their 70s and 5.63 (95% CI; 4.63\u0026ndash;6.85) for those aged 80 years and older compared with those under 50 years of age [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. COPD is an independent risk factor for lung cancer [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. COPD is the most frequently cited risk factor for PPCs, with an odds ratio of 2.36 (95% CI; 1.90\u0026ndash;2.93) for the occurrence of PPCs attributable to COPD [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The odds ratio for developing PPCs after thoracic surgery was notably high at 4.24 (95% CI; 2.89\u0026ndash;6.23) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, sufficient risk management of PPCs during surgery for COPD-related lung cancer, particularly in older patients, is essential. In Japan, the prevalence of COPD in patients aged\u0026thinsp;\u0026ge;\u0026thinsp;70 years is 24.4% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The complication rate of lung cancer in COPD is reported to be approximately 9.1% [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Conversely, 50% of the patients with lung cancer are found to have COPD [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. According to the Japanese Association for Thoracic Surgery annual reports, in 2018, patients aged\u0026thinsp;\u0026ge;\u0026thinsp;70 years accounted for 58.6% (26,305/44,859 patients) of all patients with lung cancer[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. During surgical treatment of lung cancer, patients with COPD had a higher incidence of complications and poorer prognosis than those without COPD [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, few reports have addressed the risk factors for postoperative complications in patients with COPD. In this study, we retrospectively investigated the risk factors for PPCs in older patients with lung cancer associated with COPD.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical statement \u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures in this study were conducted in accordance with the ethical standards set by the Institutional Ethics Committee and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Kanazawa Medical University Institutional Ethics Committee granted approval for access to and use of patient data in April 2020 for this study (approval numbers: I160 and I449). \u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePatients\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll clinical data were collected retrospectively. The study included patients aged \u0026ge;70 years who underwent surgery for non-small-cell lung cancer (NSCLC) associated with COPD between January 2009 and December 2018. Patients were divided into two groups based on the postoperative grade 2 or higher pulmonary complications evaluated using the Clavien\u0026ndash;Dindo classification (CDC) [12]. \u003c/p\u003e\n\u003cp\u003eThe following variables were assessed: preoperative characteristics (age, sex, body mass index, Brinkman index, comorbidity, Charlson comorbidity index [CCI] [13], preoperative laboratory data, neutrophil-to-lymphocyte ratio [14], prognostic nutritional index [15], geriatric nutritional risk index [16], pulmonary function values, and COPD stage); surgical and pathological characteristics (surgical approach, procedure, nodal dissection, operation time, amount of bleeding, histology, pathological stage, and intraoperative findings [adhesion, bi-lobectomy or pneumonectomy or combined resection, intraoperative air leakage, blood vessel injury, thoracotomy conversion or re-thoracotomy, polyglycolic acid (PGA) sheet use, and fibrin glue use]); and perioperative morbidities (complications, morbidity, chest tube duration, postoperative hospital stay duration, and mortality). Tumors were classified and staged according to the Union for International Cancer Control tumor-node-metastasis classification for malignant tumors [17]. All surgeries were performed by the chief surgeon, with patient follow-up conducted on an outpatient basis. Surgical techniques included complete video-assisted thoracoscopic surgery (VATS) was performed thorough two ports with an incision of 5 cm or less, and hybrid VATS was performed with one or two ports through a 5\u0026ndash;10-cm-wide incision. Systemic or lobe-specific lymph node dissection (LND) was performed in patients undergoing segmentectomy, lobectomy, bi-lobectomy, or pneumonectomy. Lymph node metastasis was determined using enhanced computed tomography (CT) and whole-body 2-deoxy-2-(18F)-fluorodeoxyglucose-positron emission tomography/CT imaging, with clinical staging applied for patients who underwent partial resection. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDiagnosis of COPD\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with coexisting COPD, who were not already treated for COPD by their primary care physician, were diagnosed based on the following criteria [18]: 1) history of exposure to risk factors such as long-term smoking; 2) post-bronchodilator spirometry result showing a forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) \u0026lt;70%, and 3) exclusion of other diseases that could cause airflow obstruction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDiagnosis of asthma\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with coexisting asthma, other than those already treated for asthma by their primary care physician, were diagnosed based on the following criteria [1]: 1) relevant history of symptoms such as recurrent episodes of paroxysmal dyspnea, wheezing, chest tightness, or coughing; 2) evidence of variable airflow obstruction on spirometry, demonstrated by reversibility testing (improvement in FEV1 of 12% and at least 200 mL); and 3) presence of inflammatory biomarkers such as fractional exhaled nitric oxide (FeNO) (\u0026gt;25 ppm), blood eosinophils (\u0026ge;300 cells/\u0026mu;L), and sputum eosinophils (\u0026ge;3%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClassification of postoperative complications\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll complications occurring within the first 3 months following lung resection were recorded, with complications being defined as any deviation from the normal postoperative course. They were identified, quantified, and stratified according to the CDC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCDC\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe CDC categorizes postoperative complications based on objective data as follows [12]. Grade 1: Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical, endoscopic, or radiological interventions Allowed therapeutic regimens are antiemetics, antipyretics, analgesics, diuretics, electrolytes, and physiotherapy. This grade also includes wound infections opened at the bedside. \u003c/p\u003e\n\u003cp\u003eGrade 2: Complications requiring pharmacological treatment with drugs beyond those allowed for grade 1; this includes blood transfusions and total parenteral nutrition. \u003c/p\u003e\n\u003cp\u003eGrade 3: Complications requiring surgical, endoscopic, or radiological intervention. Grade 3a: Interventions not requiring general anesthesia such as bronchoscopic toileting, chest drainage tube insertion under local anesthesia, pleurodesis therapy, and home oxygen therapy. Grade 3b: Interventions requiring general anesthesia such as tracheostomy, fenestration, and reoperation. \u003c/p\u003e\n\u003cp\u003eGrade 4: Life-threatening complications (including central nervous system complications) requiring intensive care unit management; mechanical ventilation, continuous hemodiafiltration, and other mechanical supports. Grade 4a: Single organ dysfunction. Grade 4b: Multiorgan dysfunction. \u003c/p\u003e\n\u003cp\u003eGrade 5: Death of the patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStatistical analyses\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analyses were conducted using JMP version 14.0 (SAS Institute Inc., Cary, North Carolina, USA). Missing data were imputed using the mean or median of the observed values. Two-category comparisons were performed using the chi-square test, Fisher\u0026rsquo;s exact test, Student\u0026rsquo;s t-test, and Mann\u0026ndash;Whitney U test for quantitative data. We used a logistic regression model for univariate and multivariate analyses. Accordingly, significant predictors (p\u0026lt;0.05) in the univariate analysis were used in the multivariate analysis to calculate hazard ratios (HRs) within patient subsets; a p-value of \u0026lt;0.05 indicated statistical significance. \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 802 patients with lung cancer underwent surgery during the study period. Of these, 797 had lung resection and 5 underwent biopsy or exploratory thoracotomy/thoracoscopy.\u0026nbsp;Moreover, 405 (50.8%) patients were aged \u0026ge;70 years, and 169 (21.2%) had coexisting COPD. However, only 153 (19.2%) patients were included in this study; 16 patients were excluded because they had secondary primary lung cancers or were diagnosed with postoperative pathological stage\u0026nbsp;IV\u0026nbsp;cancer or small cell lung cancer.\u0026nbsp;Grade 2 or higher PPCs were observed in 42 (27.5%) out of 153 patients (\u003cstrong\u003eFigure 1\u003c/strong\u003e).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePreoperative patient characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe analyzed data from 153 patients (129 men and 26 women) with a mean age of 76.2 (standard deviation [SD], 4.5; range, 70\u0026ndash;90) years (\u003cstrong\u003eTable 1\u003c/strong\u003e). The median Brinkman index was 1000 (interquartile range [IQR], 600\u0026ndash;1620). Among the patients, 15 (9.8%), 7 (4.6%), 26 (17.0%), 15 (9.8%), 35 (22.9%), 52 (34.0%), and 17 (11.1%) patients had asthma, interstitial pneumonia, heart disease, arrhythmia, malignant tumors in other organs, diabetes mellitus, and cerebrovascular disease, respectively. The median CCI was 5 (IQR 4\u0026ndash;6). Asthma comorbidities were significantly more common in the PPC group than in the non-PPC group (p=0.003). Furthermore, hemoglobin levels were significantly lower in the PPC group than in the non-PPC group (p=0.044). There were no significant differences in preoperative laboratory data, immunonutritional indices, and pulmonary function values.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003ePreoperative characteristics of patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 235px;\"\u003e\n \u003cp\u003ePostoperative pulmonary complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003eTotal (n=153)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eGrade \u0026ge;2 (n=42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eGrade \u0026lt;2 (n=111)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAge (years); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e76.2 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e76.3 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e76.2 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.847\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eMale sex; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e129 (84.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e33 (78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e96 (86.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.230\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eBody mass index; median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e23.1 (21.2-25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e23.2 (20.5-25.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e23.1 (21.3-25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.868\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eBrinkman index; median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1000 (600-1620)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1040 (622.5-1675)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1000 (500-1600)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.415\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAsthma; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e15 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e9 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e6 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.003\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eInterstitial pneumonia; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e7 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e7 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.096\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eHeart disease; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e26 (17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e6 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e20 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.583\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eArrythmia; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e15 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e4 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e11 (9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.943\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eMalignant neoplasms; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e35 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e9 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e26 (23.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.793\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eDiabetes mellitus; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e52 (34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e14 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e38 (34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.916\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eCerebrovascular disease; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e17 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e5 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e12 (10.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.849\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eCharlson comorbidity index; median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e5 (4-6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.725\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003ePreoperative laboratory data\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eHemoglobin (g/dL); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e13.4 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e12.9 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e13.6 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.044\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eLeucocyte (/\u0026mu;L); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e6109.2 (1885.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e5946.7 (2086.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e6170.6 (1810.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.514\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eLymphocyte (/\u0026mu;L); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1529.1 (515.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1459.3 (485.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1555.5 (526.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.304\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNatrium (mmol/L); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e141.0 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e140.7 (2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e141.1 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.418\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eAlbumin (g/dL); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e4.0 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e3.9 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e4.0 (0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.274\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eImmunonutritional index\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eNeutrophil to lymphocyte ratio; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e2.8 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e2.8 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e2.7 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.844\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003ePrognostic nutritional index; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e47.7 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e46.7 (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e48.1 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.143\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eGeriatric nutritional risk index; mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e102.8 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e102.0 (12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e103.1 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.541\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003ePulmonary function value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eSpO2 (%); median (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e97 (96-97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e97 (96-97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e97 (96-97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.453\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003e%VC (%); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e102.7 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e105.7 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e101.6 (15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.168\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003e%FVC (%); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e101.2 (16.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e103.8 (19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e100.2 (15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.220\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eFEV1 (mL); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1915.2 (463.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1864.0 (433.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e1934.6 (474.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.402\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003e%FEV1 (%); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e80.5 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e82.2 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e79.9 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.469\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eFEV1% (%); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e60.5 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e59.6 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e60.8 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.395\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 285px;\"\u003e\n \u003cp\u003eCOPD stage I; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e77 (50.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e20 (47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e57 (51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.680\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCategorical data are shown as numbers (%) and continuous data are shown mean (SD) or median (IQR). COPD: chronic obstructive lung disease, FEV1: forced vital capacity in 1 second, FVC: forced vital capacity, IQR: interquartile range, SD: standard deviation, SpO2: percutaneous oxygen saturation, VC: vital capacity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e[Table 1]\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eSurgical outcomes and perioperative and pathological characteristics of patients\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe surgical approaches used included complete VATS, hybrid VATS, and open thoracotomy in 38 (24.8%), 94 (61.4%), and 21 (13.7%) patients, respectively (\u003cstrong\u003eTable 2\u003c/strong\u003e). The surgical procedures performed were, wedge resection; segmentectomy; lobectomy; and bi-lobectomy, pneumonectomy, and extended resection were performed in 48 (31.4%), 11 (7.2%), 71 (46.4%), and 23 (15.3%) patients, respectively. Accordingly, LND was performed in patients who underwent segmentectomy, lobectomy, or other procedures excluding wedge resection. Lymph node sampling, lobe-specific LND, and systemic LND were conducted in 32 (20.9%), 26 (17.0%), and 45 (29.4%) patients, respectively.\u0026nbsp;The mean operation time and amount of bleeding were 176.3 (SD, 98.4) min and 101.6 (SD, 183.6) mL, respectively. Histological examination revealed adenocarcinoma, squamous cell carcinoma (Sq), and other malignancies in 96 (62.7%), 47 (30.7%), and 10 (6.5%) patients, respectively. Other malignancies included five large cell neuroendocrine carcinomas, three adenosquamous carcinomas, one pleomorphic carcinoma, and one typical carcinoid. Pathological staging indicated that 112 patients (73.2%) were in stages 0/I, 27 patients (17.6%) in stage II, and 13 patients (9.2%) in stage III. Thoracotomy was significantly more common (p = 0.002), and operation time was significantly longer (p = 0.006) in the PPC group than in the non-PPC group. In addition, Sq (p = 0.010) and stage III lung cancer (p = 0.010) were more prevalent in the PPC group than in the non-PPC group. There was no significant difference between the two groups in terms of intraoperative factors such as adhesion, surgical procedures (bi-lobectomy, pneumonectomy, or extended resection), intraoperative air leakage, blood vessel injury, thoracotomy conversion or re-thoracotomy, and PGA sheet use. However, the use of fibrin glue was significantly lower in the PPC group than in the non-PPC group (p = 0.023).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Intraoperative and postoperative characteristics of the patients\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 245px;\"\u003e\n \u003cp\u003ePostoperative pulmonary complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eTotal (n=153)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eGrade \u0026ge;2 (n=42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eGrade \u0026lt;2 (n=111)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eApproach; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eComplete VATS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e38 (24.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e5 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e33 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.002\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eHybrid VATS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e94 (61.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e25 (59.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e69 (92.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eThoracotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e21 (13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e12 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e9 (8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eProcedure; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eWedge resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e48 (31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e9 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e39 (35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.195\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eSegmentectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e11 (7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e3 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e8 (7.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eLobectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e71 (46.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e20 (47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e51 (46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eBilob/Pn/Ex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e23 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e10 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e13 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eNodal dissection; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e50 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e10 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e40 (36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.416\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eSampling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e32 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e11 (26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e21 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eLobe-specific\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e26 (17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e9 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e17 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eSystemic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e45 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e12 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e33 (29.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eOperation time (min); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e176.3 (98.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e215.5 (109.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e161.5 (89.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.006\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eAmount of bleeding (mL); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e101.6 (183.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e153.3 (270.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e82.0 (133.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.109\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eHistology; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eAdenocarcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e96 (62.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e24 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e72 (64.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.010\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eSquamous cell carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e47 (30.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e18 (42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e29 (26.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eOther types\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e10 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e10 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003ePathological stage; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003e0, I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e112 (73.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e26 (61.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e86 (77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.010\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e27 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e7 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e20 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e13 (9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e9 (21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e5 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eIntraoperative findings; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eAdhesion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e53 (34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e17 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e36 (32.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.351\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eBilob/Pn/Ex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e23 (15.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e10 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e13 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.062\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eIntraoperative leakage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e60 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e21 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e39 (35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.093\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eBlood vessel injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e10 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e4 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e6 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.356\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eThoracotomy conversion due to bleeding,\u0026nbsp;\u003cbr\u003e\u0026nbsp;Re-thoracotomy in the operating room\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e9 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e4 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e5 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.239\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003ePGA sheet use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e100 (65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e24 (57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e76 (68.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.189\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 289px;\"\u003e\n \u003cp\u003eFibrin glue use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e135 (88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e33 (78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e102 (91.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.023\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCategorical data are shown as numbers (%) and continuous data are shown as mean (SD) or median (IQR). Bilob: bi-lobectomy, Ex: extended resection, IQR: interquartile range, PGA: polyglycoric acid, Pn: pneumonectomy, SD: standard deviation, VATS: video-assisted thoracic surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e[Table 2]\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003ePostoperative morbidities and outcomes\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e summarizes the PPCs observed in this cohort, and \u003cstrong\u003eTable 4\u003c/strong\u003e summarizes the morbidities during the perioperative period. PPCs of CDC grade 2 or higher occurred in 42 (27.5%) patients. CDC grades 4, 3, and 2 were observed in 2 (1.3%), 37 (25.5%), and 5 (3.3%) patient, respectively. Forty-six PPCs were observed in 42 patients. Pulmonary fistula, defined as pleurodesis (grade 3), was the most common pulmonary complication (n=25; 16.3%), and other complications included atelectasis and sputum discharge disorder (n=6; 3.9%), pneumonia (n=5; 3.3%), respiratory failure (n=4; 2.6%), asthma (n=2; 1.3%), contralateral pneumothorax (n=2; 1.3%), bronchopleural fistula (n=1; 0.7%), and acute exacerbation of interstitial pneumonia (n=1; 0.7%). Additionally, eight (5.2%) patients with non-pulmonary complications were observed. All-grade arrhythmias were observed in 29 (18.9 %) cases. The chest tube duration (p=0.002) and postoperative hospital duration (p=0.029) were significantly longer in the PPC group than in the non-PPC group. No perioperative deaths occurred within 1 month. Importantly, no hospital deaths occurred within 3 months. There were no deaths (CDC grade 5) at the 30-day or 90-day follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3\u003c/strong\u003e. Postoperative pulmonary complications observed in this cohort\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003eGrade 4 PPCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003ePneumonia (mechanical ventilation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003eGrade 3 PPCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003ePulmonary fistula\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\n \u003cp\u003e25 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003eAtelectasis, sputum discharge disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\n \u003cp\u003e6 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003eRespiratory failure (HOT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\n \u003cp\u003e4 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003eContralateral pneumothorax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003eBronchopleural fistula\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003ePneumonia (bronchoscopic toileting)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003eGrade 2 PPCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003ePneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003eAsthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003eIPAE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003ePPCs grade 3 or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\n \u003cp\u003e36 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 83.5417%;\"\u003e\n \u003cp\u003ePPCs grade 2 or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.4583%;\"\u003e\n \u003cp\u003e42 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eno. (% of total [n=153]). HOT: home oxygen therapy, IPAE: acute exacerbation of interstitial pneumonia, PPC: postoperative pulmonary complication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 4. Morbidities during the perioperative period\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003ePostoperative pulmonary complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eTotal (n=152)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eGrade \u0026ge;2 (n=41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eGrade \u0026lt;2 (n=111)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003eChest tube duration (day); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.9 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e5.1 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e2.1 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.002\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003ePostoperative hospital duration (day); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e17.1 (32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e32 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e11.4 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.029\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003e30-day mortality; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003e90-day mortality; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003eNon-postoperative pulmonary complications\u003cbr\u003e\u0026nbsp; (Grade 3 or higher); no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e3 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e5 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.526\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003eGrade 4 non-PPCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003eRenal failure (CHDF)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003eGrade 3 non-PPCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003eChylothorax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e2 (1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003ePleural effusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003ePostoperative bleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003eArrythmia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1 (0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 311px;\"\u003e\n \u003cp\u003eArrythmia (all grade); no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e29 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e12 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e17 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.062\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCategorical data are shown as numbers (%) and continuous data are shown as mean (SD). CHDF: continuous hemodiafiltration, PPC: postoperative pulmonary complication, SD: standard deviation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e[Table 4]\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eUnivariate and multivariate analyses to identify risk factors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e presents the results of univariate and multivariate analyses. Coexisting asthma (presence or absence), coexisting anemia (hemoglobin \u0026lt;12.2 g/dL), surgical approach (thoracotomy or VATS), operation time (\u0026gt;220 min), histology (Sq or non-Sq), pathological stage (III or 0\u0026ndash;II), and intraoperative use of fibrin glue (use or not use) were extracted from the chi-square test, Fisher\u0026rsquo;s exact test, Student\u0026rsquo;s t-test, and Mann\u0026ndash;Whitney U test and used in univariate analysis. Univariate analysis revealed that coexisting asthma was associated with a significantly higher HR (HR, 4.772; 95% confidence interval [CI], 1.604\u0026ndash;15.192; p = 0.005), other significant factors included coexisting anemia (HR, 2.765; 95% CI, 1.204\u0026ndash;6.371; p = 0.017), thoracotomy approach (HR, 4.533; 95% CI, 1.757\u0026ndash;12.117; p=0.002), operation time \u0026gt;220 min (HR, 3.034; 95% CI, 1.405\u0026ndash;6.584; p=0.005), and pathological stage III disease (HR, 5.782; 95% CI, 1.865\u0026ndash;19.958; p=0.002). Conversely, the use of fibrin glue (HR, 0.323; 95% CI, 0.119\u0026ndash;0.883; p=0.028) significantly reduced the HR. Subsequently, significant risk factors (p\u0026lt;0.05) in the univariate analysis including coexisting asthma, coexisting anemia, thoracotomy approach, operation time \u0026gt;220 min, pathological stage III, and the use of fibrin glue, were further evaluated in multivariate analysis. Multivariate analysis revealed that coexisting asthma significantly increased HR (HR, 3.602; 95% CI, 1.007\u0026ndash;12.881; p = 0.049), and the use of fibrin glue significantly reduced HR (HR, 0.323; 95% CI, 0.105\u0026ndash;0.992; p = 0.048).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5\u003c/strong\u003e. Univariate and multivariate analyses\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 33.2353%;\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 33.2353%;\"\u003e\n \u003cp\u003eMultivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003eAsthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e4.772\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e1.604\u0026ndash;15.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e3.602\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e1.007\u0026ndash;12.881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.049\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003eAnemia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003eHb = 12.1 g/dL or less\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e2.765\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e1.204\u0026ndash;6.321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.017\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e2.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e0.837\u0026ndash;5.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003eApproach\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003eThoracotomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e4.533\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e1.757\u0026ndash;12.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e2.380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e0.728\u0026ndash;-7.779\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003eOperation time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003e220 min or more\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e3.034\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e1.405\u0026ndash;6.584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e1.456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e0.573\u0026ndash;3.699\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.430\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003eHistology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003eSq\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e2.004\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e0.858\u0026ndash;4.618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003ePathological stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e5.782\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e1.865\u0026ndash;19.958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e2.272\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e0.550\u0026ndash;9.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003eFibrin glue use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.3235%;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e0.323\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e0.119\u0026ndash;0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 2.20588%;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7.94118%;\"\u003e\n \u003cp\u003e0.323\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.1765%;\"\u003e\n \u003cp\u003e0.105\u0026ndash;0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.11765%;\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e95% CI; 95% confidence interval, Hb: Hemoglobin, HR; hazard ratio, Sq: squamous cell carcinoma.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eImpact of asthma and fibrin glue use on lung complications after lung resection\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe impact of coexisting asthma, identified as a risk factor for PPC, on adverse pulmonary outcomes was evaluated (\u003cstrong\u003eTable 6\u003c/strong\u003e). PPCs of CDC grades 4, 3, and 2 were observed in 2 (13.3%), 7 (21.2%), and 1 (6.7%) patients, respectively. Ten PPCs were observed in 9 (60.0%) patients. Atelectasis and sputum discharge disorder were the most prevalent PPCs (n=45; 26.7%), followed by pulmonary fistula (n=3; 20.0%), pneumonia (n=2; 13.3%), and asthma (n=1; 6.7%). No significant differences were observed in chest tube and postoperative hospital duration between the patients with and without PPCs. Asthma comorbidity was significantly associated with PPCs (grade \u0026ge;2, p=0.003; grade \u0026ge;3, p=0.004). In particular, the frequencies of grade \u0026ge;3 pneumonia, atelectasis, and sputum discharge disorders were significantly higher in the asthma group than in the non-asthma group (p\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn contrast, the group that used fibrin glue intraoperatively had significantly fewer PPCs than the group that did not (grade \u0026ge;2, p=0.023; grade \u0026ge;3, p=0.005). Among these, 11 CDC grade 3 PPCs were observed in 9 (50.0%) patients. The most common PPC was pulmonary fistula (n=5; 27.8%), followed by respiratory failure (n=2; 11.1%), atelectasis and sputum discharge disorder (n=1; 5.6%), pneumonia (n=1; 5.6%), contralateral pneumothorax (n=1; 5.6%), and bronchopleural fistula (n=1; 5.6%). The incidence of grade \u0026ge;3 pulmonary fistulas tended to be lower in the group that used fibrin glue than in the group that did not. However, no significant difference in the prevalence of individual PPCs or a consistent trend was observed between the two groups. In addition, the two groups showed no significant differences in chest tube and postoperative durations.\u003c/p\u003e\n\u003cp\u003eTable 6. Impacts of asthma and fibrin glue on lung complications after lung resection\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eAsthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eTotal (n=153)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eWith (n=15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eWithout (n=137)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePostoperative pulmonary complication; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eGrade 4 PPCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePneumonia (mechanical ventilation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eGrade 3 PPCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePulmonary fistula\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e25 (16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e22 (15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.694\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eAtelectasis, sputum discharge disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e6 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eRespiratory failure (HOT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e4 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e4 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eContralateral pneumothorax\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eBronchopleural fistula\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePneumonia (bronchoscopic toileting)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eGrade 2 PPCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2 (1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eAsthma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2 (1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eIPAE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePPCs grade 3 or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e36 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e8 (53.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e28 (20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePPCs grade 2 or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e42 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e9 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e33 (23.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePneumonia, atelectasis, sputum discharge disorder (Grade 3 or higher); no, (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e9 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e3 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eFibrin glue use; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e135 (88.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e15 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e120 (87.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.046\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eIntraoperative air leakage; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e60 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e6 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e54 (39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.948\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eChest tube duration (day); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2.9 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e3.7 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2.8 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.406\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePostoperative hospital duration (day); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e17.1 (32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e52.0 (95.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e13.3 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.138\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 190px;\"\u003e\n \u003cp\u003eFibrin glue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eTotal (n=153)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eUse (n=135)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eNot use (n=18)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePPCs grade 3 or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e36 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e27 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e9 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePPCs grade 2 or higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e42 (27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e33 (24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e9 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePulmonary fistula (Grade 3 or higher)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e25(16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e20 (14.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e5 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePneumonia, atelectasis, sputum discharge disorder (Grade 3 or higher); no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e9 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e7 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.360\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eCoexisting asthma; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e15 (9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e15 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eIntraoperative air leakage; no. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e60 (39.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e58 (43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e2 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003eChest tube duration (day); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2.8 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.8 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e4.2 (7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 334px;\"\u003e\n \u003cp\u003ePostoperative hospital duration (day); mean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e17.0 (32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e16.7 (33.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e20.2 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCategorical data are shown as numbers (%) and continuous data are shown as mean (SD). HOT: home oxygen therapy, IPAE: acute exacerbation of interstitial pneumonia, PPC: postoperative pulmonary complication, SD: standard deviation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e[Table 6]\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we identified asthma as a risk factor for PPCs in COPD-associated lung cancer. Postoperative grade \u0026ge;3 complications, including pneumonia, atelectasis, and sputum discharge disorder were approximately 10 times more frequent in patients with asthma than in those without asthma. Distinguishing, asthma from COPD becomes increasingly difficult with age, and the prevalence of the asthma-COPD overlap phenotype in patients with COPD is approximately 21.4% (range 8.6\u0026ndash;33%) [4]. While patients with well-controlled asthma are not considered at risk of PPCs [19], poor control increases the risk of bronchospasm [20, 21]. Therefore, sufficient attention to asthma control status and medical history is essential during preoperative assessments. In this study, 15 patients with asthma underwent inhaler therapy, and no asthma attack was reported within the 3 months before surgery. Among these patients, four received triple inhaler therapy with an inhaled corticosteroid (ICS), a long-acting \u0026beta;2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA); nine patients received dual inhaler therapy with an ICS and a LABA, one received LABA and LAMA dual inhaler therapy, and one patient received LABA single inhaler therapy. Despite good asthma control, the frequency of PPCs remained notably high. Asthma is typically associated with airway hyperresponsiveness and inflammation [22]. FeNO, an indicator of airway inflammation, is often elevated in chronic lung disease conditions such as asthma and asthma-COPD overlap [23]. Preoperative FeNO levels are significant predictors of surgical outcomes after lung resection [24] and abdominal surgery [25]. Although FeNO was not assessed in this study, its preoperative measurement may be important in predicting PPCs.\u003c/p\u003e\n\u003cp\u003ePulmonary surgery involves several anesthetic invasions, such as exposure to high concentrations of oxygen, isolated lung ventilation, positive pressure ventilation, and direct surgical intervention into the lung parenchyma and peripheral airways during surgery [26]. These invasions exacerbate airway secretions during chronic airway inflammation in asthma and COPD. Additionally, a postoperative decline in the FEV1 may cause sputum discharge disorder, atelectasis, and pneumonia [27]. The effectiveness of inhaled medication may be insufficient due to reduced intake caused by postoperative pain or inadiquate understanding of inhalation techniques in older patients [28].\u003c/p\u003e\n\u003cp\u003ePreventing of air leaks after lung resection for cancer is essential for successful early postoperative outcomes. In our department, fibrin glue and PGA sheets are actively used during surgery for the following reasons: 1) to prevent postoperative air leakage or reinforce fragile lungs in patients with COPD and 2) to cover and fix free pericardial fat to the bronchial stump to prevent bronchopleural fistula [29]. While fibrin glue use resulted in fewer PPCs as a composite outcome, we confirmed that the incidence rate of grade 3 pulmonary fistula was not significant. However, using fibrin glue during surgery to prevent air leakage reduced postoperative pulmonary fistula by approximately 50%. In the 60 cases where intraoperative air leakage was observed, the incidence of grade \u0026ge;3 pulmonary fistulas was 14 (24.1%) in the fibrin glue group, compared with 2 (100%) in the non-use group. Thus, the frequency of postoperative pulmonary fistula was significantly lower in the fibrin glue group than in the non-use group (p=0.017, data not shown). Although this study did not quantitatively evaluate air leakage, the use of fibrin glue was thought to contribute to the control of postoperative pulmonary fistulas. On the other hand, all 15 patients with asthma used fibrin glue. Six of the 15 cases (40%) developed complications such as pneumonia, atelectasis, and sputum discharge disorder. Although this study did not examine the patient\u0026apos;s allergic backgrounds, there have been reports of eosinophilic pneumonia [30] and eosinophilic pleural effusion [31] associated with the use of fibrin glue during surgery. This raises the possibility that fibrin glue may induce pneumonia or increase airway secretions in patients with certain allergic predispositions.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLimitations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis study has some limitations that should not be overlooked. First, the analysis was based on a small sample size from a single institution. Patients over the age of 70 years with COPD accounted for only 19% of those who underwent surgery at our institution during the study period, introducing potential selection bias. Second, there may be inconsistencies in the diagnosis of asthma between patients\u0026rsquo; primary care physicians and our hospital, and the study did not directly distinguish between well-or-poorly controlled asthma. Therefore, we will continue to study the postoperative effects of airway inflammation and hypersensitivity by modalities such as FeNO measurement on patients with NSCLC and rank them based on the severity of the illness. Further prospective large-scale studies are required to address this issue.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eAsthma is a significant risk factor for PPCs in older patients with NSCLC associated with COPD. Surgical indications and postoperative care should be carefully considered in patients with asthma. Although intraoperative use of fibrin glue was found to reduce the risk of PPCs in the multivariate analysis, subsequent examinations did not definitively confirm its effectiveness in preventing complications. However, intraoperative use of fibrin glue for patients who experienced intraoperative air leakage was found to reduce the risk of PPCs, especially pulmonary fistula in older patients with NSCLC associated with COPD. Previous reports of fibrin glue-induced PPCs underscore the need to use it with caution.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCCI, Charlson comorbidity index; CDC, Clavien\u0026ndash;Dindo classification; CI, confidence interval; COPD, chronic obstructive pulmonary disorder; CT, computed tomography; FeNO, fractional exhaled nitric oxide; FEV1, forced expiratory volume in 1 s; HR, hazard ratio; ICS, inhaled corticosteroid; IQR, interquartile range; LABA, long-acting \u0026beta;2-agonist; LAMA, long-acting muscarinic antagonist; LND, lymph node dissection; NSCLC, non-small cell lung cancer; PGA, polyglycolic acid; PPCs, postoperative pulmonary complications; SD, standard deviation; Sq, squamous cell carcinoma; VATS, video-assisted thoracoscopic surgery\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures in this study were conducted in accordance with the ethical standards set by the Institutional Ethics Committee and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Kanazawa Medical University Institutional Ethics Committee granted approval for access to and use of patient data in April 2020 (approval numbers: I160 and I449).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interest\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eYI conceptualized and conducted the study, and performed a literature search. TM, MI, SI, and AY supervised the manuscript preparation, and critically revised the manuscript. NM, and HU supervised the manuscript preparation and critically revised the manuscript. All authors have reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to all the patients who participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eLouis R, Satia I, Ojanguren I, Schleich F, Bonini M, Tonia T, et al. European respiratory society guidelines for the diagnosis of asthma in adults. Eur Respir J. 2022; doi: 10.1183/13993003.01585-2021.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eSmetana GW. Postoperative pulmonary complications: an update on risk assessment and \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;reduction. Cleve Clin J Med. 2009;76 Suppl 4:S60-5. doi: 10.3949/ccjm.76.s4.10.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eSmetana GW, Lawrence VA, Cornell JE; American College of Physicians. Preoperative pulmonary risk stratification for noncardiothoracic surgery: systematic review for the American College of Physicians. Ann Intern Med. 2006;144:581-95. doi: 10.7326/0003-4819-144-8-200604180-00009\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eGibson PG, McDonald VM. Asthma-COPD overlap 2015: now we are six. Thorax. 2015;70:683-91. doi: 10.1136/thoraxjnl-2014-206740\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eSmith MC, Wrobel JP. Epidemiology and clinical impact of major comorbidities in patients with COPD. Int J Chron Obstruct Pulm Dis. 2014; 9:871-88. doi: 10.2147/COPD.S49621\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eKiri VA, Soriano J, Visick G, Fabbri L. Recent trends in lung cancer and its association with COPD: an analysis using the UK GP research database. Prim Care Respir J. 2010;19:57-61. doi: 10.4104/pcrj.2009.00048\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eRodr\u0026iacute;guez LA, Wallander MA, Mart\u0026iacute;n-Merino E, Johansson S. Heart failure, myocardial infarction, lung cancer and death in COPD patients: a UK primary care study. Respir Med. 2010;104:1691-9. doi: 10.1016/j.rmed.2010.04.018\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eFukuchi Y, Nishimura M, Ichinose M, Adachi M, Nagai A, Kuriyama T, et al. COPD in Japan: the Nippon COPD Epidemiology study. Respirology. 2004;9:458-65. doi: 10.1111/j.1440-1843.2004.00637.x\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eYoung RP, Hopkins RJ, Christmas T, Black PN, Metcalf P, Gamble GD. COPD prevalence is increased in lung cancer, independent of age, sex and smoking history. Eur Respir J. 2009;34:380-6. doi: 10.1183/09031936.00144208\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eCommittee for Scientific Affairs, The Japanese Association for Thoracic Surgery; Shimizu H, Okada M, Toh Y, Doki Y, Endo S, Fukuda H et al. Thoracic and cardiovascular surgeries in Japan during 2018 : Annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2021;69:179-212. doi: 10.1007/s11748-020-01460-w\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eSekine Y, Yamada Y, Chiyo M, Iwata T, Nakajima T, Yasufuku K \u003cem\u003eet al\u003c/em\u003e. Association of chronic obstructive pulmonary disease and tumor recurrence in patients with stage IA lung cancer after complete resection. Ann Thorac Surg. 2007;84:946-50. doi: 10.1016/j.athoracsur.2007.04.038\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eDindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13. doi: 10.1097/01.sla.0000133083.54934.ae\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eCharlson ME, Charlson RE, Peterson JC, Marinopoulos SS, Briggs WM, Hollenberg JP. The Charlson comorbidity index is adapted to predict costs of chronic disease in primary care patients. J Clin Epidemiol. 2008;61:1234-40. doi: 10.1016/j.jclinepi.2008.01.006\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eDusselier M, Deluche E, Delacourt N, Ballouhey J, Egenod T, Melloni B \u003cem\u003eet al\u003c/em\u003e. Neutrophil-to-lymphocyte ratio evolution is an independent predictor of early progression of second-line nivolumab-treated patients with advanced non-small-cell lung cancers. PLoS One. 2019;14:e0219060. doi: 10.1371/journal.pone.0219060\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eOkada S, Shimada J, Kato D, Tsunezuka H, Teramukai S, Inoue M. Clinical significance of prognostic nutritional index after surgical treatment in lung cancer. Ann Thorac Surg. 2017; 104:296-302. doi: 10.1016/j.athoracsur.2017.01.085\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eBouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I \u003cem\u003eet al\u003c/em\u003e. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82:777-83. doi: 10.1093/ajcn/82.4.777\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eJames DB, Mary KG, Christian W. UICC TNM Classification of malignant tumors. 8th ed. Hoboken, NJ: Wiley-Blackwell; 2016.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eThe Japanese Respiratory society. The JRS Guidelines for the management of chronic obstructive pulmonary disease 2022. Tokyo: Medical Review; 2022. (in Japanese)\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eQaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006;144:575-80. doi: 10.7326/0003-4819-144-8-200604180-00008\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eWarner DO, Warner MA, Barnes RD, Offord KP, Schroeder DR, Gray DT, et al. Perioperative respiratory complications in patients with asthma. Anesthesiology. 1996;85:460-7. doi: 10.1097/00000542-199609000-00003\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eWoods BD, Sladen RN. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth. 2009;103 Suppl 1: i57-65. doi: 10.1093/bja/aep271\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eReddel HK, Bacharier LB, Bateman ED, Brightling CE, Brusselle GG, Buhl R, et al. Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes. Eur Respir J. 2022;59:2102730. doi: 10.1183/13993003.02730-2021\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eNiimi A, Matsumoto H, Mishima M. Eosinophilic airway disorders associated with chronic cough. Pulm Pharmacol Ther. 2009;22:114-20. doi: 10.1016/j.pupt.2008.12.001\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eOkamoto K, Hayashi K, Kaku R, Kawaguchi Y, Oshio Y, Hanaoka J. Impact of fractional exhaled nitric oxide on the outcomes of lung resection surgery: a prospective study. J Thorac Dis. 2020;12:2663-71. doi: 10.21037/jtd.2020.03.18\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003ePi X, Wang C, Li Y, Zheng J, Cui Y, Guo L \u003cem\u003eet al\u003c/em\u003e. Preoperative FeNO as a screening indicator of pulmonary complications after abdominal surgery in patients over 60 years old. J Breath Res. 2015;9:036004. doi: 10.1088/1752-7155/9/3/036004\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eG\u0026uuml;ldner A, Kiss T, Serpa Neto A, Hemmes SN, Canet J, Spieth PM \u003cem\u003eet al\u003c/em\u003e. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology. 2015;123:692-713. doi: 10.1097/ALN.0000000000000754\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eSawabata N, Nagayasu T, Kadota Y, Goto T, Horio H, Mori T \u003cem\u003eet al\u003c/em\u003e. Risk assessment of lung resection for lung cancer according to pulmonary function: republication of systematic review and proposals by guideline committee of the Japanese association for chest surgery 2014. Gen Thorac Cardiovasc Surg. 2015;63:14-21. doi: 10.1007/s11748-014-0475-x\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eBozek A, Jarzab J. Adherence to asthma therapy in elderly patients. J Asthma. 2010;47:162-5. doi: 10.3109/02770900903497204\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eUramoto H, Nakajima Y, Kinoshita H. Is the isolated pericardial fat pad sufficient to cover the bronchial stump and separate the pulmonary artery in order to prevent bronchopleural fistula in patients with lung cancer?. Anticancer Res. 2016;36:2385-9.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eKawamoto N, Okita R, Hayashi M, Okada M, Ito K, Ikeda E, et al. Suspected fibrin glue-induced acute eosinophilic pneumonia after pulmonary resection: a case report. Thorac Cancer. 2021;12:2126-9. doi: 10.1111/1759-7714.14040\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eKawamoto N, Okita R, Okada M, Ito K, Hirazawa K, Inokawa H. Fibrin glue-induced eosinophilic pleural effusion after pulmonary resection: a case report. Int J Surg Case Rep. 2021;85:106239. doi: 10.1016/j.ijscr.2021.106239\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"older patients, non-small cell lung cancer, chronic obstructive pulmonary disease, surgery, postoperative complication","lastPublishedDoi":"10.21203/rs.3.rs-4945929/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4945929/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe risk factors for postoperative complications in patients with chronic obstructive pulmonary disease (COPD) remain unclear. In this study, we aimed to identify the risk factors for postoperative pulmonary complications in older patients with lung cancer associated with COPD.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively analyzed the data from 153 older patients who underwent pulmonary surgery for non-small-cell lung cancer associated with COPD between 2009 and 2018. Patients were categorized into two groups based on the presence or absence of Clavien\u0026ndash;Dindo classification grade\u0026thinsp;\u0026ge;\u0026thinsp;2 pulmonary complications. We examined their clinicopathological characteristics and outcomes. Differences between the groups were assessed using univariate and multivariate analyses to identify risk factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003ePulmonary complications occurred in 42 (27.5%) patients. The group with postoperative complications had significantly longer durations of chest tube use and hospital stay than the group without complications. No perioperative or hospital deaths occurred within 1 or 3 months. Univariate analysis identified coexisting asthma, anemia (hemoglobin\u0026thinsp;\u0026lt;\u0026thinsp;12.2 g/dL), thoracotomy approach, prolonged operation time (\u0026gt;\u0026thinsp;220 min), pathological stage III, and fibrin glue use as risk factors for postoperative pulmonary complications. Multivariate analysis confirmed coexisting asthma and fibrin glue use as significant risk factors.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAsthma is a risk factor for postoperative pulmonary complications, particularly pneumonia, atelectasis, and sputum discharge disorder, and intraoperative fibrin glue use significantly reduced postoperative pulmonary complications, in our patient population. Surgical indications and postoperative care should be carefully considered in patients with asthma.\u003c/p\u003e","manuscriptTitle":"Asthma is risk factor for complication after lung resection in older patients with non-small cell lung cancer associated with chronic obstructive pulmonary disease: a retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-16 13:47:02","doi":"10.21203/rs.3.rs-4945929/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6ef78f79-7a97-4063-8f49-99779185368b","owner":[],"postedDate":"October 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-08T09:39:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-10-16 13:47:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4945929","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4945929","identity":"rs-4945929","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}