Preoperative evaluation of the pacient with bronchopulmonary cancer

Abstract

BACKGROUND.In the Republic of Moldova, we have reported 983 cases of bronchopulmonary cancer (BPC) annually, in 2019. This impressive number of patients requires a more efficient mobilization of the medical system to solve these cases. AIM. The high incidence of newly diagnosed cases of BPC in advanced stages implies a reserved attitude for the surgical treatment of these patients, as well as the presence of associated pathologies, compromise more the situations, and the possibility to provide effective solutions to solve these cases. The group of patients who have tertiary prevention as a measure of treatment becomes imposing. This order of ideas outlines the need for a different medical-surgical approach for this category of patients. METHODS AND RESULTS.For the assessment of functional criteria for operability for patients with BPC, especially in advanced lung cancer, using comorbidity scores (ASA, Charlson, Elixhauser) and the formation of indications for surgical treatment are significant, because surgery offers the greatest opportunity for healing. The team responsible for the preoperative assessment should include both a perioperative mortality risk assessment and a postoperative pulmonary function prediction to optimally advise patients on anticipated outcomes. Due to both advanced cancer on presentation and comorbid conditions, only one-third of patients are ultimately considered candidates for surgical resection. Despite modern surgical, anesthetic, and postoperative techniques, there is still a perioperative mortality rate of 1-5%. Postoperative myocardial infarction is an important source of morbidity and mortality for those undergoing extensive lung resections, especially trans-pericardial pneumonectomies. Until surgery is suggested, preoperative evaluation of the cardiovascular system should be required for the existence of active heart disease (unstable angina, recent myocardial infarction, decompensated heart failure, arrhythmias, or valve defects).In addition to identifying cardiac risk factors, a preoperative assessment is incomplete without quantifying a patient's functional capacity. This can be achieved by the results of a formal stress test, measured in units of metabolic equivalents of task (MET). Geriatric assessment (GA) is a method used to collect information about the physical condition of elderly patients, which may be useful in estimating life expectancy and predicting treatment toxicity. GA includes an assessment of functional status, fatigue, cognitive function, mental health, nutritional status, the individual's ability to complete instrumental activities of daily living, comorbidities, social support, and the presence of geriatric syndromes. CONCLUSIONS. A thorough analysis of the results of diagnostic tests, referring to the functional evaluation of patients with advanced BPC and/or comorbidities, would allow the extension of surgical indications to obtain new results and increase over time the survival and quality of life of these patients.