Präoperative Funktionsdiagnostik vor lungenresezierenden Eingriffen

Abstract

Preoperative risk stratification for lung surgery requires the determination of FEV1 and TLCO. Calculation of relative values and predective postoperative values in dependence on the extent of resection is preferable in comparison to absolute values. National and international guidelines have different recommendations for preoperative functional assessment. In general they recommend cardiopulmonary exercise testing if preoperative FEV1 and TLCO are < 80%-pred. or if ppo values are < 40%-pred. Inoperability is assumed if ppo values of V'O2-max are < 10 ml/kg/min or < 35%-pred. On this basis, a more simplified algorithm for the preoperative assessment of candidates for lung resection (Hemer algorithm) is presented. Nevertheless, there still remain some unresolved questions. These concern the assessment of the individual operative risk of patients who are at or just beyond the limits of functional operability. Furthermore, there is the fact that patients - in spite of a severe functional impairment - are willing to accept a higher risk of morbidity and mortality, especially if there is a curative option.