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A randomized multicenter Phase II study of perioperative tiotropium intervention in gastric cancer patients with chronic obstructive pulmonary disease.

Fushida S, Oyama K, Kaji M, Hirono Y, Kinoshita J, Tsukada T, Nezuka H, Nakano T, Noto M, Nishijima K, Fujimura T, Ohta T - Int J Chron Obstruct Pulmon Dis (2015)

Bottom Line: Postoperative complications, forced expiratory volume in 1 second, forced vital capacity, and the ratio of forced expiratory volume in second to forced vital capacity (%) were compared between the two groups.There were no significant differences between the two groups in terms of age, body mass index, smoking, gastrectomy incision, operation time, and bleeding volume (all P>0.05).A subgroup analysis of gastric cancer patients with moderate COPD showed that perioperative tiotropium intervention significantly decreased the rate of postoperative complications compared with the control group (P=0.046).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterological Surgery, Kanazawa University Hospital, Kanazawa, Japan ; Digestive Disease Support Organization (DDSO), Kanazawa, Japan.

ABSTRACT

Background: Tiotropium, a long-acting inhaled anticholinergic drug, has been widely used in the treatment of chronic obstructive pulmonary disease (COPD). However, the issue of whether perioperative tiotropium improves postoperative outcomes for gastric cancer patients with COPD remains unclear. Thus, the aim of this study was to determine the efficacy of perioperative tiotropium intervention for gastric cancer patients with COPD.

Patients and methods: Eighty-four gastric cancer patients with mild-to-moderate COPD were randomly assigned to receive perioperative pulmonary rehabilitation alone (control group) or pulmonary rehabilitation with 18 µg of tiotropium once daily (tiotropium group). The patients in the tiotropium group received tiotropium for more than 1 week before surgery and for 2 weeks after surgery. Spirometry was performed prior to group assignment and at 2 weeks after surgery. Postoperative complications, forced expiratory volume in 1 second, forced vital capacity, and the ratio of forced expiratory volume in second to forced vital capacity (%) were compared between the two groups.

Results: There were no significant differences between the two groups in terms of age, body mass index, smoking, gastrectomy incision, operation time, and bleeding volume (all P>0.05). Postoperative complications and pulmonary functions did not differ significantly between the control and tiotropium groups. A subgroup analysis of gastric cancer patients with moderate COPD showed that perioperative tiotropium intervention significantly decreased the rate of postoperative complications compared with the control group (P=0.046). However, even after gastrectomy, many patients with mild COPD in both the control and tiotropium groups showed improved pulmonary function.

Conclusion: Although perioperative tiotropium intervention had no significant effects in gastric cancer patients with mild COPD, it may be beneficial in those with moderate COPD. Therefore, the next prospective study should further evaluate perioperative tiotropium intervention for gastric cancer patients with moderate-to-severe COPD.

No MeSH data available.


Related in: MedlinePlus

Changed percentage of postoperative FEV1/FVC compared with preoperative values.Notes: In comparison with the preoperative values, postoperative FEV1/FVC was 4.7% in the control group and 6.7% in the tiotropium group. There was also no significant difference in FEV1/FVC among the two groups.Abbreviation: FEV1/FVC, ratio of forced expiratory volume after 1 second to forced vital capacity.
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f4-copd-10-2177: Changed percentage of postoperative FEV1/FVC compared with preoperative values.Notes: In comparison with the preoperative values, postoperative FEV1/FVC was 4.7% in the control group and 6.7% in the tiotropium group. There was also no significant difference in FEV1/FVC among the two groups.Abbreviation: FEV1/FVC, ratio of forced expiratory volume after 1 second to forced vital capacity.

Mentions: Postoperative pulmonary function parameters, including FEV1, FVC, and FEV1/FVC (%), were evaluated in comparison with their preoperative values. Mean decreased rate of FEV1 was 1.12% in the control group and −0.73% in the tiotropium group. A decrease in FEV1 of more than 20% was seen in only three patients (7.9%) in the control group and four patients (9.5%) in the tiotropium group (Figure 2). There was no significant difference in FEV1 between the two groups. Mean rate of FVC compared with preoperative value was 93.1% in the control group and 92.1% in the tiotropium group. A reduction in FVC of more than 20% was seen in three patients (7.9%) in the control group and in nine patients (21.4%) in the tiotropium group (Figure 3). No significant difference was found in FVC between the two groups. Mean changed FEV1/FVC (%) was 4.7% in the control group and 6.7% in the tiotropium group. Although there was no significant difference in FEV1/FVC among two groups (Figure 4), the COPD severity decreased in 18 patients in the control group and in 24 patients in the tiotropium group. None of these patients had spirometry results that indicated COPD (Table 2). The mean length O2 support after surgery was 3 (range: 1–10) days in the control group and 3 (range: 1–16) days in the tiotropium group. There was no significant difference between the two groups.


A randomized multicenter Phase II study of perioperative tiotropium intervention in gastric cancer patients with chronic obstructive pulmonary disease.

Fushida S, Oyama K, Kaji M, Hirono Y, Kinoshita J, Tsukada T, Nezuka H, Nakano T, Noto M, Nishijima K, Fujimura T, Ohta T - Int J Chron Obstruct Pulmon Dis (2015)

Changed percentage of postoperative FEV1/FVC compared with preoperative values.Notes: In comparison with the preoperative values, postoperative FEV1/FVC was 4.7% in the control group and 6.7% in the tiotropium group. There was also no significant difference in FEV1/FVC among the two groups.Abbreviation: FEV1/FVC, ratio of forced expiratory volume after 1 second to forced vital capacity.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608619&req=5

f4-copd-10-2177: Changed percentage of postoperative FEV1/FVC compared with preoperative values.Notes: In comparison with the preoperative values, postoperative FEV1/FVC was 4.7% in the control group and 6.7% in the tiotropium group. There was also no significant difference in FEV1/FVC among the two groups.Abbreviation: FEV1/FVC, ratio of forced expiratory volume after 1 second to forced vital capacity.
Mentions: Postoperative pulmonary function parameters, including FEV1, FVC, and FEV1/FVC (%), were evaluated in comparison with their preoperative values. Mean decreased rate of FEV1 was 1.12% in the control group and −0.73% in the tiotropium group. A decrease in FEV1 of more than 20% was seen in only three patients (7.9%) in the control group and four patients (9.5%) in the tiotropium group (Figure 2). There was no significant difference in FEV1 between the two groups. Mean rate of FVC compared with preoperative value was 93.1% in the control group and 92.1% in the tiotropium group. A reduction in FVC of more than 20% was seen in three patients (7.9%) in the control group and in nine patients (21.4%) in the tiotropium group (Figure 3). No significant difference was found in FVC between the two groups. Mean changed FEV1/FVC (%) was 4.7% in the control group and 6.7% in the tiotropium group. Although there was no significant difference in FEV1/FVC among two groups (Figure 4), the COPD severity decreased in 18 patients in the control group and in 24 patients in the tiotropium group. None of these patients had spirometry results that indicated COPD (Table 2). The mean length O2 support after surgery was 3 (range: 1–10) days in the control group and 3 (range: 1–16) days in the tiotropium group. There was no significant difference between the two groups.

Bottom Line: Postoperative complications, forced expiratory volume in 1 second, forced vital capacity, and the ratio of forced expiratory volume in second to forced vital capacity (%) were compared between the two groups.There were no significant differences between the two groups in terms of age, body mass index, smoking, gastrectomy incision, operation time, and bleeding volume (all P>0.05).A subgroup analysis of gastric cancer patients with moderate COPD showed that perioperative tiotropium intervention significantly decreased the rate of postoperative complications compared with the control group (P=0.046).

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterological Surgery, Kanazawa University Hospital, Kanazawa, Japan ; Digestive Disease Support Organization (DDSO), Kanazawa, Japan.

ABSTRACT

Background: Tiotropium, a long-acting inhaled anticholinergic drug, has been widely used in the treatment of chronic obstructive pulmonary disease (COPD). However, the issue of whether perioperative tiotropium improves postoperative outcomes for gastric cancer patients with COPD remains unclear. Thus, the aim of this study was to determine the efficacy of perioperative tiotropium intervention for gastric cancer patients with COPD.

Patients and methods: Eighty-four gastric cancer patients with mild-to-moderate COPD were randomly assigned to receive perioperative pulmonary rehabilitation alone (control group) or pulmonary rehabilitation with 18 µg of tiotropium once daily (tiotropium group). The patients in the tiotropium group received tiotropium for more than 1 week before surgery and for 2 weeks after surgery. Spirometry was performed prior to group assignment and at 2 weeks after surgery. Postoperative complications, forced expiratory volume in 1 second, forced vital capacity, and the ratio of forced expiratory volume in second to forced vital capacity (%) were compared between the two groups.

Results: There were no significant differences between the two groups in terms of age, body mass index, smoking, gastrectomy incision, operation time, and bleeding volume (all P>0.05). Postoperative complications and pulmonary functions did not differ significantly between the control and tiotropium groups. A subgroup analysis of gastric cancer patients with moderate COPD showed that perioperative tiotropium intervention significantly decreased the rate of postoperative complications compared with the control group (P=0.046). However, even after gastrectomy, many patients with mild COPD in both the control and tiotropium groups showed improved pulmonary function.

Conclusion: Although perioperative tiotropium intervention had no significant effects in gastric cancer patients with mild COPD, it may be beneficial in those with moderate COPD. Therefore, the next prospective study should further evaluate perioperative tiotropium intervention for gastric cancer patients with moderate-to-severe COPD.

No MeSH data available.


Related in: MedlinePlus