Abstract
Purpose of ReviewSurgery is considered the best treatment option for patients with early stage lung cancer. Nevertheless, lung resection may cause a variable functional impairment that could influence the whole cardio-respiratory system with potential life-threatening complications. The aim of the present study is to review the most relevant evidences about the evaluation of surgical risk before lung resection, in order to define a practical approach for the preoperative functional assessment in lung cancer patients.Recent FindingsThe first step in the preoperative functional evaluation of a lung resection candidate is a cardiac risk assessment. The predicted postoperative values of forced expiratory volume in one second and carbon monoxide lung diffusion capacity should be estimated next. If both values are greater than 60 % of the predicted values, the patients are regarded to be at low surgical risk. If either or both of them result in values lower than 60 %, then a cardiopulmonary exercise test is recommended. Patients with VO2max >20 mL/kg/min are regarded to be at low risk, while those with VO2max <10 mL/kg/min at high risk. Values of VO2max between 10 and 20 mL/kg/min require further risk stratification by the VE/VCO2 slope. A VE/VCO2 <35 indicates an intermediate-low risk, while values above 35 an intermediate-high risk.SummaryThe recent scientific evidence confirms that the cardiologic evaluation, the pulmonary function test with DLCO measurement, and the cardiopulmonary exercise test are the cornerstones of the preoperative functional evaluation before lung resection. We present a simplified functional algorithm for the surgical risk stratification in lung resection candidates.
Highlights
During the last 40 years, an increasing amount of papers addressed the topic of perioperative risk assessment in the field of lung surgery.At the end of the eighties, the attention was focused on the spirometric parameters, lung volumes and flows, as potential predictors of poor outcome when preoperatively impaired
The aim of the present study is to review the most relevant evidences about the evaluation of surgical risk before lung resection, in order to define a practical approach for the preoperative functional assessment in lung cancer patients
The predicted postoperative values of forced expiratory volume in one second and carbon monoxide lung diffusion capacity should be estimated. If both values are greater than 60 % of the predicted values, the patients are regarded to be at low surgical risk
Summary
During the last 40 years, an increasing amount of papers addressed the topic of perioperative risk assessment in the field of lung surgery. At the end of the eighties, the attention was focused on the spirometric parameters, lung volumes and flows, as potential predictors of poor outcome when preoperatively impaired As it became clear in the following decade, the spirometric evaluation was not able to discriminate per se the surgical risk, and some other factors, such as the lung diffusion capacity, had to be considered for predicting the risk of morbidity and mortality. These parameters were adopted as the standard of the preoperative functional assessment before lung resection at the end of the last century. They were considered the first-level examination step before proceeding to more sophisticated evaluation strategies, as
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