Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery

Abstract

Background: This section of the guidelines is intended to provide an evidence-based approach to the preoperative physiologic assessment of a patient being considered for surgical resection of lung cancer. Methods: The current guidelines and medical literature applicable to this issue were identifi ed by computerized search and were evaluated using standardized methods. Recommendations were framed using the approach described by the Guidelines Oversight Committee. Results: The preoperative physiologic assessment should begin with a cardiovascular evaluation and spirometry to measure the FEV 1 and the diffusing capacity for carbon monoxide (D LCO ). Pre- dicted postoperative (PPO) lung functions should be calculated. If the % PPO FEV 1 and % PPO D LCO values are both . 60%, the patient is considered at low risk of anatomic lung resection, and no further tests are indicated. If either the % PPO FEV 1 or % PPO D LCO are within 60% and 30% pre- dicted, a low technology exercise test should be performed as a screening test. If performance on the low technology exercise test is satisfactory (stair climbing altitude . 22 m or shuttle walk distance . 400 m), patients are regarded as at low risk of anatomic resection. A cardiopulmonary exercise test is indicated when the PPO FEV 1 or PPO D LCO (or both) are , 30% or when the performance of the stair-climbing test or the shuttle walk test is not satisfactory. A peak oxygen consumption ( O 2 peak) , 10 mL/kg/min or 35% predicted indicates a high risk of mortality and long-term disability for major anatomic resection. Conversely, a O 2 peak . 20 mL/kg/min or 75% pre- dicted indicates a low risk. Conclusions: A careful preoperative physiologic assessment is useful for identifying those patients at increased risk with standard lung cancer resection and for enabling an informed decision by the patient about the appropriate therapeutic approach to treating his or her lung cancer. This preoperative risk assessment must be placed in the context that surgery for early-stage lung can- cer is the most effective currently available treatment of this disease.