Fit for surgery? Assessment of marginal lung cancer patients

Abstract

Surgical treatment is still a treatment of choice for many stage-1-IIIA lung cancer patients. Owing to modern methods of risk management, the option of surgery has now extended to patient groups that would have been rejected from surgery 10-15 yrs ago. Patients with COPD constitute the majority of such patients, followed by patients with associated cardiac comorbidity and elderly patients undergoing lung resection. In these patients, the risk of post-operative complications and death exists independently of the level of surgical skills and post-operative care. Similarly, patients undergoing lung resection after neoadjuvant treatment and previous pleural empyema, or patients requiring very extended resections, are exposed to an increased risk of operative morbidity and mortality. The possibility of unpredicted complications make the pre-operative selection even more delicate. Each of these patient groups requires a specific, multidisciplinary approach that necessitates close collaboration between pulmonary physicians, thoracic oncologists and thoracic surgeons.