Evaluation of Functional Operability Prior to Lung Surgery

Abstract

Cardiac and pulmonary physiologic assessment is necessary for risk stratification before any lung resection. It may uncover hidden health issues, which can be addressed first to make patients fit for surgery. It allows for the surgeon to estimate the patient's risk for major complications and at the same time for the patient to understand the procedural risks and give informed consent or even reject surgery. Recommended work-up for both to cardiac risk evaluation and preoperative pulmonary function test algorithms are based on guidelines formulated by the ERS/ESTS and ACCP 1 3 4.Basic pulmonary function tests consist of spirometry, blood gas analysis and measurement of diffusion capacity (DLCO); followed by cardiopulmonary exercise testing (CPET) which estimates or measures the patient's oxygen consumption, and split function tests such as perfusion scintigraphy. Clinical assessment of both the patient's overall status and pulmonary function allows for an adequate assessment of overall operative risk. Pulmonary function tests are affected by multiple variables and as such prone to error. It is advisable to always question the validity of every work-up and to repeat any test if necessary.