Preoperative evaluation of patients undergoing lung resection surgery.

Lung cancer continues to be the leading case of cancer deaths in the United States. In patients with resectable non-small cell lung cancer, surgical resection is the treatment of choice. An accurate preoperative general and pulmonary-specific evaluation is essential as postoperative complications and morbidity of lung resection surgery are significant. After confirming anatomic resectability, patients must undergo a thorough evaluation to determine their ability to withstand the surgery and the loss of the resected lung. The measurement of spirometric indexes (ie, FEV(1)) and diffusing capacity of the lung for carbon monoxide (DLCO) should be performed first. If FEV(1) and DLCO are > 60% of predicted, patients are at low risk for complications and can undergo pulmonary resection, including pneumonectomy, without further testing. However, if FEV(1) and DLCO are < 60% of predicted, further evaluation by means of a quantitative lung scan is required. If lung scan reveals a predicted postoperative (ppo) values for FEV(1) and DLCO of > 40%, the patient can undergo lung resection. If the ppo FEV(1) and ppo DLCO are < 40%, exercise testing is necessary. If this reveals a maximal oxygen uptake (O(2)max) of > 15 mL/kg, surgery can be undertaken. If the O(2)max is < 15 mL/kg, surgery is not an option. This review discusses the existing modalities for preoperative evaluation prior to lung resection surgery.

[1]  D. Hillman,et al.  Preoperative assessment as a predictor of mortality and morbidity after lung resection. , 1989, The American review of respiratory disease.

[2]  S. Miyoshi,et al.  Exercise tolerance test in lung cancer patients: the relationship between exercise capacity and postthoracotomy hospital mortality. , 1987, The Annals of thoracic surgery.

[3]  C. Bolliger,et al.  Prospective evaluation of an algorithm for the functional assessment of lung resection candidates. , 1999, American journal of respiratory and critical care medicine.

[4]  Graves Ej,et al.  1986 summary: National Hospital Discharge Survey. , 1984, Advance data.

[5]  L. Wetstein,et al.  Assessment of exercise oxygen consumption as preoperative criterion for lung resection. , 1987, The Annals of thoracic surgery.

[6]  R. Morice,et al.  Exercise testing in the evaluation of patients at high risk for complications from lung resection. , 1992, Chest.

[7]  C. Mittman.  Assessment of operative risk in thoracic surgery. , 1961, The American review of respiratory disease.

[8]  M. Ferguson.  Assessment of operative risk for pneumonectomy. , 1999, Chest surgery clinics of North America.

[9]  Segall Jj,et al.  Ventilatory capacity in chronic bronchitis in relation to carbon dioxide retention. , 1966, Scandinavian journal of respiratory diseases.

[10]  H. E. Hanson,et al.  Temporary unilateral occlusion of the pulmonary artery; a new method of determining separate lung function and of radiologic examinations. , 1951, The Journal of thoracic surgery.

[11]  F. Bergan.  A simple method for determination of the relative function of the right and left lung. , 1960, Acta chirurgica Scandinavica. Supplementum.

[12]  A. Flahault,et al.  Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. , 2000, Chest.

[13]  Taylor Murray,et al.  Cancer statistics, 1999 , 1999, CA: a cancer journal for clinicians.

[14]  G. Olsen,et al.  The evolving role of exercise testing prior to lung resection. , 1989, Chest.

[15]  D. van Nostrand,et al.  Preresectional evaluation of risk from pneumonectomy. , 1968, Surgery, gynecology & obstetrics.

[16]  B. Juhl,et al.  A Comparison between Measured and Calculated Changes in the Lung Function after Operation for Pulmonary Cancer , 1975, Acta anaesthesiologica Scandinavica. Supplementum.

[17]  C. Eastridge,et al.  Preoperative assessment of the high-risk patient for lung resection. , 1996, The Annals of thoracic surgery.

[18]  G. D. Gass,et al.  Preoperative pulmonary function testing to predict postoperative morbidity and mortality. , 1986, Chest.

[19]  Weisman Im,et al.  Role of exercise stress testing in preoperative evaluation of patients for lung resection. , 1994 .

[20]  L. Uggla.  A clinical study in advanced cases examined with cardiac catheterization and temporary unilateral occlusion of the pulmonary artery. , 1957, Acta tuberculosea Scandinavica. Supplementum.

[21]  C. Mittman.  Assessment of operative risk in thoracic surgery. , 1962, The New physician.

[22]  T. Rice,et al.  Exercise testing, 6-min walk, and stair climb in the evaluation of patients at high risk for pulmonary resection. , 1992, Chest.

[23]  C. Bolliger,et al.  Exercise capacity as a predictor of postoperative complications in lung resection candidates. , 1995, American journal of respiratory and critical care medicine.

[24]  J. Segall,et al.  Ventilatory capacity in chronic bronchitis in relation to carbon dioxide retention. , 1966, Scandinavian journal of respiratory diseases.

[25]  N. Cherniack,et al.  A bronchospirometric method of estimating the effect of pneumonectomy on the maximum breathing capacity. , 1968, The Journal of thoracic and cardiovascular surgery.

[26]  P. Kirchner,et al.  Clinical value of quantitative ventilation-perfusion lung scans in the surgical management of bronchogenic carcinoma. , 1980, The Journal of thoracic and cardiovascular surgery.

[27]  D. Mark,et al.  Patient and hospital characteristics related to in-hospital mortality after lung cancer resection. , 1992, Chest.

[28]  R. Hetzer,et al.  Re-excitation of the cardioplegic heart. A possible hazard in clinical cardioplegic arrest. , 1981, The Thoracic and cardiovascular surgeon.

[29]  P. Corris,et al.  Use of radionuclide scanning in the preoperative estimation of pulmonary function after pneumonectomy. , 1987, Thorax.

[30]  Marshall Mc,et al.  The physiologic evaluation of the lung resection candidate. , 1993 .

[31]  M. L. Ladurie,et al.  Uncertainties in the expected value for forced expiratory volume in one second after surgery. , 1986, Chest.

[32]  Graves Ej,et al.  National Hospital Discharge Survey , 2004 .

[33]  H. Berggren,et al.  Hospital mortality and long-term survival in relation to preoperative function in elderly patients with bronchogenic carcinoma. , 1984, The Annals of thoracic surgery.

[34]  B. Celli,et al.  Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery. , 2001, Chest.

[35]  A. J. Block,et al.  Relationship between preoperative pulmonary function tests and complications after thoracotomy. , 1981, Surgery, gynecology & obstetrics.

[36]  G. Murray,et al.  Correlation of preoperative pulmonary function testing with clinical course in patients after pneumonectomy. , 1983, The Annals of thoracic surgery.

[37]  W. O’Connor,et al.  Thrombotic catastrophe in the patient with multiple Björk-Shiley prostheses. , 1983, The Annals of thoracic surgery.

[38]  C. Bolliger,et al.  Lung scanning and exercise testing for the prediction of postoperative performance in lung resection candidates at increased risk for complications. , 1995, Chest.

[39]  A. J. Block,et al.  Prediction of postpneumonectomy pulmonary function using quantitative macroaggregate lung scanning. , 1974, Chest.

[40]  Miller Ji,et al.  Pulmonary function test criteria for operability and pulmonary resection. , 1981 .

[41]  D. Sugarbaker,et al.  Assessment of operative risk in patients undergoing lung resection. Importance of predicted pulmonary function. , 1994, Chest.

[42]  L. North,et al.  Clinical course related to preoperative and postoperative pulmonary function in patients with bronchogenic carcinoma. , 1971, Chest.

[43]  D. Cugell,et al.  The role of pulmonary insufficiency in mortality and invalidism following surgery for pulmonary tuberculosis. , 1955, The Journal of thoracic surgery.

[44]  C. Hornung,et al.  Stair climbing as an exercise test to predict the postoperative complications of lung resection. Two years' experience. , 1991, Chest.

[45]  J. Miller,et al.  Pulmonary function test criteria for operability and pulmonary resection. , 1981, Surgery, gynecology & obstetrics.

[46]  S. Kristersson,et al.  Prediction of pulmonary function loss due to pneumonectomy using 133 Xe-radiospirometry. , 1972, Chest.

[47]  G. Glonek,et al.  Diffusing capacity predicts morbidity and mortality after pulmonary resection. , 1988, The Journal of thoracic and cardiovascular surgery.

[48]  C. Hornung,et al.  Submaximal invasive exercise testing and quantitative lung scanning in the evaluation for tolerance of lung resection. , 1989, Chest.

[49]  G. Anderson,et al.  Use of Medicare claims data to evaluate outcomes in elderly patients undergoing lung resection for lung cancer. , 1991, Chest.

[50]  M. C. Marshall,et al.  The physiologic evaluation of the lung resection candidate. , 1993, Clinics in chest medicine.

[51]  G. Kinasewitz,et al.  Exercise capacity as a predictor of post-thoracotomy morbidity. , 2015, The American review of respiratory disease.