Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.

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 identified 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 FEV1 and the diffusing capacity for carbon monoxide (Dlco). Predicted postoperative (PPO) lung functions should be calculated. If the % PPO FEV1 and % PPO Dlco 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 FEV1 or % PPO Dlco are within 60% and 30% predicted, 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 FEV1 or PPO Dlco (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 (V˙O2 peak) < 10 mL/kg/min or 35% predicted indicates a high risk of mortality and long-term disability for major anatomic resection. Conversely, a V˙O2 peak > 20 mL/kg/min or 75% predicted 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 cancer is the most effective currently available treatment of this disease.

[1]  G. Saumon Pump and circumstances. , 2003, American journal of respiratory and critical care medicine.

[2]  B. Lahiri,et al.  Preoperative evaluation of patients undergoing lung resection surgery. , 2003, Chest.

[3]  R. Mckenna,et al.  Combined operations for lung volume reduction surgery and lung cancer. , 1996, Chest.

[4]  J. E. Hansen,et al.  Exercise-induced myocardial ischemia detected by cardiopulmonary exercise testing. , 2009, The American journal of cardiology.

[5]  R. Mick,et al.  Optimizing selection of patients for major lung resection. , 1995, The Journal of thoracic and cardiovascular surgery.

[6]  M. Hoaglin,et al.  Diffusion lung capacity for carbon monoxide (DLCO) is an independent prognostic factor for long‐term survival after curative lung resection for cancer , 2009, Journal of surgical oncology.

[7]  A. Bernard,et al.  Surgical treatment of lung cancer in the octogenarians: results of a nationwide audit. , 2011, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[8]  D. Sugarbaker,et al.  Lung resection in patients with preoperative FEV1 < 35% predicted. , 2005, Chest.

[9]  A. Brunelli,et al.  Predictors of early morbidity after major lung resection in patients with and without airflow limitation. , 2002, The Annals of thoracic surgery.

[10]  D. Lackland,et al.  Specialists achieve better outcomes than generalists for lung cancer surgery. , 1998, Chest.

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

[12]  H. Tsukuma,et al.  Relationship between the duration of the preoperative smoke-free period and the incidence of postoperative pulmonary complications after pulmonary surgery. , 2001, Chest.

[13]  B. Celli,et al.  Predicting complications after pulmonary resection. Preoperative exercise testing vs a multifactorial cardiopulmonary risk index. , 1993, Chest.

[14]  R. Cerfolio,et al.  General thoracic surgery is safe in patients taking clopidogrel (Plavix). , 2010, The Journal of thoracic and cardiovascular surgery.

[15]  G. Colice,et al.  The physiologic evaluation of patients with lung cancer being considered for resectional surgery. , 2003, Chest.

[16]  R. Marasco,et al.  Evaluation of expiratory volume, diffusion capacity, and exercise tolerance following major lung resection: a prospective follow-up analysis. , 2007, Chest.

[17]  T. Treasure,et al.  Assessment of whether in-hospital mortality for lobectomy is a useful standard for the quality of lung cancer surgery: retrospective study , 2003, BMJ : British Medical Journal.

[18]  Sidney Chocron,et al.  The Thoracic Surgery Scoring System (Thoracoscore): risk model for in-hospital death in 15,183 patients requiring thoracic surgery. , 2007, The Journal of thoracic and cardiovascular surgery.

[19]  S. Murgu,et al.  Follow-up and surveillance of the patient with lung cancer after curative-intent therapy: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. , 2013, Chest.

[20]  E. Hannan,et al.  The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer. , 2002, Surgery.

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

[22]  J Dowie,et al.  Choosing the surgical mortality threshold for high risk patients with stage Ia non-small cell lung cancer: insights from decision analysis , 2002, Thorax.

[23]  J. Miller,et al.  Pathologic findings in lung volume reduction surgery. , 1998, Chest.

[24]  H. Maeda,et al.  Fall in diffusing capacity associated with induction therapy for lung cancer: a predictor of postoperative complication? , 2006, The Annals of thoracic surgery.

[25]  Malte Kelm,et al.  Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. , 2009, European heart journal.

[26]  Dina Brooks,et al.  ATS statement on six-minute walk test. , 2003, American journal of respiratory and critical care medicine.

[27]  A. Groves,et al.  Relationship of shuttle walk test and lung cancer surgical outcome. , 2004, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[28]  B. Celli,et al.  Estimation of ventilatory reserve by stair climbing. A study in patients with chronic airflow obstruction. , 1993, Chest.

[29]  A. Brunelli,et al.  Stair climbing test as a predictor of cardiopulmonary complications after pulmonary lobectomy in the elderly. , 2004, The Annals of thoracic surgery.

[30]  C. Pompili,et al.  Low-technology exercise test in the preoperative evaluation of lung resection candidates. , 2010, Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace.

[31]  A. Mussi,et al.  Robotically assisted lobectomy: learning curve and complications. , 2008, Thoracic surgery clinics.

[32]  R. Dillman,et al.  Surgical resection and long-term survival for octogenarians who undergo surgery for non-small-cell lung cancer. , 2009, Clinical lung cancer.

[33]  D. Baldwin,et al.  Diagnosis and treatment of lung cancer: summary of updated NICE guidance , 2011, BMJ : British Medical Journal.

[34]  L. Tanoue Impact of Smoking Cessation Before Resection of Lung Cancer: A Society of Thoracic Surgeons General Thoracic Surgery Database Study , 2011 .

[35]  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.

[36]  C. Gebitekin,et al.  Preoperative maximal exercise oxygen consumption test predicts postoperative pulmonary morbidity following major lung resection , 2007, Respirology.

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

[38]  D. Waller,et al.  Is there a role for therapeutic lobectomy for emphysema? , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[39]  Sara Twaddle,et al.  The Scottish Intercollegiate Guidelines Network (Sign): An Update , 2005, Scottish medical journal.

[40]  K. Kerr,et al.  Guidelines on the radical management of patients with lung cancer , 2010, Thorax.

[41]  M. Takahama,et al.  Assessment of pulmonary function after lobectomy for lung cancer--upper lobectomy might have the same effect as lung volume reduction surgery. , 2006, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[42]  M. Peberdy,et al.  Usefulness of decrease in oxygen uptake efficiency slope to identify myocardial perfusion defects in men undergoing myocardial ischemic evaluation. , 2010, The American journal of cardiology.

[43]  D. Hillman,et al.  Preoperative Assessment as a Predictor of Mortality and Morbidity after Lung Resection , 1989 .

[44]  D. Addrizzo-Harris,et al.  Methodology for development of guidelines for lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. , 2013, Chest.

[45]  Yukihito Saito,et al.  Early postoperative mobilization with walking at 4 hours after lobectomy in lung cancer patients , 2007, General thoracic and cardiovascular surgery.

[46]  C. Bolliger,et al.  Preoperative assessment for lung cancer surgery , 2005, Current opinion in pulmonary medicine.

[47]  A. Verduri,et al.  Changes in pulmonary function test and cardio-pulmonary exercise capacity in COPD patients after lobar pulmonary resection. , 2005, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[48]  Herng‐Ching Lin,et al.  Association between surgeon and hospital volume and in-hospital fatalities after lung cancer resections: the experience of an Asian country. , 2007, The Annals of thoracic surgery.

[49]  G. Juliá-Serdá,et al.  Hospital volume: operative morbidity, mortality and survival in thoracotomy for lung cancer. A Spanish multicenter study of 2994 cases. , 2006, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[50]  R. Cerfolio,et al.  Intercostal muscle flap reduces the pain of thoracotomy: a prospective randomized trial. , 2005, The Journal of thoracic and cardiovascular surgery.

[51]  C. Pompili,et al.  Minute ventilation-to-carbon dioxide output (VE/VCO2) slope is the strongest predictor of respiratory complications and death after pulmonary resection. , 2012, The Annals of thoracic surgery.

[52]  J. Hankinson,et al.  Standardisation of spirometry , 2005, European Respiratory Journal.

[53]  J. Luketich,et al.  Standardized exercise oximetry predicts postpneumonectomy outcome. , 1997, The Annals of thoracic surgery.

[54]  H. Thaler,et al.  Influence of preoperative exercise capacity on length of stay after thoracic cancer surgery. , 2007, The Annals of thoracic surgery.

[55]  L. Goldman,et al.  ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy) , 2009, European Respiratory Journal.

[56]  Steven Piantadosi,et al.  A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. , 2003, The New England journal of medicine.

[57]  N. Altorki,et al.  Thoracoscopic lobectomy is associated with lower morbidity than open lobectomy: a propensity-matched analysis from the STS database. , 2010, The Journal of thoracic and cardiovascular surgery.

[58]  I. Yoshino,et al.  Long-term surgical outcome in patients with lung cancer and coexisting severe COPD. , 2009, The Thoracic and cardiovascular surgeon.

[59]  Homer Yang,et al.  The effects of perioperative β-blockade: Results of the Metoprolol after Vascular Surgery (MaVS) study, a randomized controlled trial , 2006 .

[60]  D. Lacombe,et al.  EORTC Elderly Task Force and Lung Cancer Group and International Society for Geriatric Oncology (SIOG) experts' opinion for the treatment of non-small-cell lung cancer in an elderly population. , 2010, Annals of oncology : official journal of the European Society for Medical Oncology.

[61]  Elizabeth H. Wood,et al.  The National Comprehensive Cancer Network (NCCN). , 2004 .

[62]  B. Toll,et al.  Treatment of tobacco use in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. , 2013, Chest.

[63]  E. Wouters,et al.  Exercise capacity before and after an 8-week multidisciplinary inpatient rehabilitation program in lung cancer patients: a pilot study. , 2006, Lung cancer.

[64]  T. Whelan,et al.  Influence of hospital characteristics on operative death and survival of patients after major cancer surgery in Ontario. , 2006, Canadian journal of surgery. Journal canadien de chirurgie.

[65]  J. E. Hansen,et al.  The utility of cardiopulmonary exercise testing to detect and track early-stage ischemic heart disease. , 2010, Mayo Clinic proceedings.

[66]  M. Bugiani,et al.  Exercise ventilatory inefficiency and mortality in patients with chronic obstructive pulmonary disease undergoing surgery for non-small-cell lung cancer. , 2010, European Journal of Cardio-Thoracic Surgery.

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

[68]  C. Keller,et al.  Histopathologic diagnosis made in lung tissue resected from patients with severe emphysema undergoing lung volume reduction surgery. , 1997, Chest.

[69]  J. Powell,et al.  Regarding "Perioperative beta-blockade (POBBLE) for patients undergoing infrarenal vascular surgery: results of a randomized double-blind controlled trial". , 2005 .

[70]  N. Nogami,et al.  Advanced age is not correlated with either short-term or long-term postoperative results in lung cancer patients in good clinical condition. , 2005, Chest.

[71]  A. Borri,et al.  Stair climbing test predicts cardiopulmonary complications after lung resection. , 2002, Chest.

[72]  G. Rocco,et al.  Carbon monoxide lung diffusion capacity improves risk stratification in patients without airflow limitation: evidence for systematic measurement before lung resection. , 2006, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[73]  J. Coebergh,et al.  Variation in treatment and outcome in patients with non-small cell lung cancer by region, hospital type and volume in the Netherlands. , 2010, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[74]  D. Brooks,et al.  A qualitative systematic overview of the measurement properties of functional walk tests used in the cardiorespiratory domain. , 2001, Chest.

[75]  J. Curtis,et al.  Lung volume reduction surgery alters management of pulmonary nodules in patients with severe COPD. , 1997, Chest.

[76]  N. Altorki,et al.  Surgical resection for lung cancer in the octogenarian. , 2004, Chest.

[77]  L. Santambrogio,et al.  Pulmonary lobectomy for lung cancer: a prospective study to compare patients with forced expiratory volume in 1 s more or less than 80% of predicted. , 2001, European Journal of Cardio-Thoracic Surgery.

[78]  Jeroen J. Bax,et al.  The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. , 1999, The New England journal of medicine.

[79]  A. Lübbe,et al.  In-patient rehabilitation of lung cancer patients—a prospective study , 2010, Supportive Care in Cancer.

[80]  L. Sharples,et al.  Cardiopulmonary exercise tests and lung cancer surgical outcome. , 2005, Chest.

[81]  D. Waller,et al.  Lobar volume reduction surgery: a method of increasing the lung cancer resection rate in patients with emphysema , 2001, Thorax.

[82]  J. Feinglass,et al.  Directing surgical quality improvement initiatives: comparison of perioperative mortality and long-term survival for cancer surgery. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[83]  Ugo Pastorino,et al.  Respiratory function changes after chemotherapy: an additional risk for postoperative respiratory complications? , 2004, The Annals of thoracic surgery.

[84]  Alessandro Brunelli,et al.  Performance at symptom-limited stair-climbing test is associated with increased cardiopulmonary complications, mortality, and costs after major lung resection. , 2008, The Annals of thoracic surgery.

[85]  V. Rusch,et al.  Lobectomy improves ventilatory function in selected patients with severe COPD. , 1998, The Annals of thoracic surgery.

[86]  C. Pompili,et al.  Peak oxygen consumption during cardiopulmonary exercise test improves risk stratification in candidates to major lung resection. , 2009, Chest.

[87]  D. Sugarbaker,et al.  Video-assisted thoracic surgery lobectomy: report of CALGB 39802--a prospective, multi-institution feasibility study. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[88]  R. Cerfolio,et al.  Changes in pulmonary function tests after neoadjuvant therapy predict postoperative complications. , 2009, The Annals of thoracic surgery.

[89]  W. Kraus,et al.  Safety and feasibility of aerobic training on cardiopulmonary function and quality of life in postsurgical nonsmall cell lung cancer patients , 2008, Cancer.

[90]  D. Waller,et al.  Lung cancer surgery in the breathless patient--the benefits of avoiding the gold standard. , 2010, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[91]  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.

[92]  L. Puente-Maestu,et al.  Early and long-term validation of an algorithm assessing fitness for surgery in patients with postoperative FEV₁ and diffusing capacity of the lung for carbon monoxide < 40%. , 2011, Chest.

[93]  M. Alifano,et al.  Early and long-term results of lung resection for non-small-cell lung cancer in patients with severe ventilatory impairment. , 2005, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[94]  C. Bolliger,et al.  Functional evaluation of the lung resection candidate. , 1998, The European respiratory journal.

[95]  C. Bolliger,et al.  Evaluation of high-risk lung resection candidates: pulmonary haemodynamics versus exercise testing. A series of five patients. , 1994, Respiration; international review of thoracic diseases.

[96]  M. Okada,et al.  Complications and outcomes after pulmonary resection for cancer in patients 80 to 89 years of age. , 2005, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[97]  N. Milman,et al.  Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma. , 1997, The European respiratory journal.

[98]  A. Kayserilioğlu,et al.  Oxygen uptake kinetics during cardiopulmonary exercise testing and postoperative complications in patients with lung cancer. , 2009, Lung cancer.

[99]  J. Birkmeyer,et al.  Surgeon volume and operative mortality in the United States. , 2003, The New England journal of medicine.

[100]  G. Rocco,et al.  Evidence of lower alteration of expiratory volume in patients with airflow limitation in the immediate period after lobectomy. , 2007, The Annals of thoracic surgery.

[101]  M. Mishima,et al.  Postoperative complications after induction chemoradiotherapy in patients with non-small-cell lung cancer. , 2006, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[102]  J. Birkmeyer,et al.  Hospital volume and operative mortality in cancer surgery: a national study. , 2003, Archives of surgery.

[103]  R. Freeman,et al.  The effect of a multidisciplinary thoracic malignancy conference on the treatment of patients with lung cancer. , 2010, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[104]  R. Cerfolio,et al.  Different diffusing capacity of the lung for carbon monoxide as predictors of respiratory morbidity. , 2009, The Annals of thoracic surgery.

[105]  C. Bolliger,et al.  Exercise capacity and extent of resection as predictors of surgical risk in lung cancer. , 2000, The European respiratory journal.

[106]  Hiroshige Nakamura,et al.  Smoking affects prognosis after lung cancer surgery , 2008, Surgery Today.

[107]  E. Antman,et al.  ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery---executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluat , 2002, Circulation.

[108]  J. Brown,et al.  Age and the treatment of lung cancer. , 1996, Thorax.

[109]  J. Reilly Evidence-based preoperative evaluation of candidates for thoracotomy. , 1999, Chest.

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

[111]  Martin Utley,et al.  The European Thoracic Surgery Database project: modelling the risk of in-hospital death following lung resection. , 2005, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[112]  T. Mineo,et al.  Quality of life after tailored combined surgery for stage I non-small-cell lung cancer and severe emphysema. , 2003, The Annals of thoracic surgery.

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

[114]  C. Hornung,et al.  Stair climbing as an indicator of pulmonary function. , 1987, Chest.

[115]  J. Barberà,et al.  Invasive exercise testing in the evaluation of patients at high-risk for lung resection. , 1998, The European respiratory journal.

[116]  Sean M. O'Brien,et al.  STS database risk models: predictors of mortality and major morbidity for lung cancer resection. , 2010, The Annals of thoracic surgery.

[117]  John P Griffin,et al.  Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition). , 2007, Chest.

[118]  R. Gesuita,et al.  POSSUM scoring system as an instrument of audit in lung resection surgery. Physiological and operative severity score for the enumeration of mortality and morbidity. , 1999, The Annals of thoracic surgery.

[119]  M. Ferguson,et al.  Assessment of pulmonary complications after lung resection. , 1999, The Annals of thoracic surgery.

[120]  Tisi Gm Preoperative evaluation of pulmonary function. Validity, indications, and benefits. , 1979 .

[121]  Shalini K Vinod,et al.  Do multidisciplinary team meetings make a difference in the management of lung cancer? , 2011, Cancer.

[122]  M. Simon,et al.  Pulmonary evaluation of surgical patients. , 1962, JAMA.

[123]  S. Bonassi,et al.  Is pulmonary function damaged by neoadjuvant lung cancer therapy? A comprehensive serial time-trend analysis of pulmonary function after induction radiochemotherapy plus surgery. , 2010, The Journal of thoracic and cardiovascular surgery.

[124]  J. Birkmeyer,et al.  Outcomes in octogenarians undergoing high-risk cancer operation: a national study. , 2007, Journal of the American College of Surgeons.

[125]  P. Postmus,et al.  Surgical Treatment for Octogenarians with Lung Cancer: Results from a Population-Based Series of 124 Patients , 2007, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[126]  M. Berry,et al.  A model for morbidity after lung resection in octogenarians. , 2011, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[127]  P. Jones,et al.  Performance, ventilation, and oxygen consumption in three different types of exercise test in patients with chronic obstructive lung disease. , 1985, Thorax.

[128]  J. Melendez,et al.  Predictive respiratory complication quotient predicts pulmonary complications in thoracic surgical patients. , 1998, The Annals of thoracic surgery.

[129]  A. Sihoe,et al.  Video-assisted thoracic surgery pulmonary resection for lung cancer in patients with poor lung function. , 2006, The Annals of thoracic surgery.

[130]  W. Vigneswaran,et al.  Validation of a modified scoring system for cardiovascular risk associated with major lung resection. , 2012, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[131]  G. Varela,et al.  Utility of standardized exercise oximetry to predict cardiopulmonary morbidity after lung resection. , 2001, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[132]  C. McArdle,et al.  An evaluation of the impact of a multidisciplinary team, in a single centre, on treatment and survival in patients with inoperable non-small-cell lung cancer , 2005, British Journal of Cancer.

[133]  F. Grannis,et al.  Impact of respiratory symptoms and pulmonary function on quality of life of long-term survivors of non-small cell lung cancer. , 2004, Chest.

[134]  S J Mentzer,et al.  Prospective analysis of pneumonectomy: risk factors for major morbidity and cardiac dysrhythmias. , 1996, The Annals of thoracic surgery.

[135]  J. Dignam,et al.  Diffusing capacity predicts long-term survival after lung resection for cancer. , 2012, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[136]  V. Rao,et al.  Exercise oximetry versus spirometry in the assessment of risk prior to lung resection. , 1995, The Annals of thoracic surgery.

[137]  S. M. Lee,et al.  The effects of pulmonary rehabilitation in the national emphysema treatment trial. , 2005, Chest.

[138]  M. Muers,et al.  Management of lung cancer. , 1996, Thorax.

[139]  M. Bains,et al.  Smoking and timing of cessation: impact on pulmonary complications after thoracotomy. , 2005, Chest.

[140]  Min P. Kim,et al.  Pulmonary resection in octogenarians with stage I nonsmall cell lung cancer: a 22-year experience. , 2004, The Annals of thoracic surgery.

[141]  C. Begg,et al.  Impact of hospital volume on operative mortality for major cancer surgery. , 1998, JAMA.

[142]  A. Davison,et al.  Telemedicine for multidisciplinary lung cancer meetings , 2004, Journal of telemedicine and telecare.

[143]  R. Pierce,et al.  Preoperative risk evaluation for lung cancer resection: predicted postoperative product as a predictor of surgical mortality. , 1994, American journal of respiratory and critical care medicine.

[144]  B. Celli What is the value of preoperative pulmonary function testing? , 1993, The Medical clinics of North America.

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

[146]  L. Sharples,et al.  Comparison of shuttle walk with measured peak oxygen consumption in patients with operable lung cancer , 2005, Thorax.

[147]  J. Roth,et al.  Resection of lung cancer is justified in high-risk patients selected by exercise oxygen consumption. , 1994, The Annals of thoracic surgery.

[148]  G. Patterson,et al.  Lung cancer resection combined with lung volume reduction in patients with severe emphysema. , 2004, The Journal of thoracic and cardiovascular surgery.

[149]  R. Stahel,et al.  ESMO Minimum Clinical Recommendations for diagnosis, treatment and follow-up of non-small-cell lung cancer (NSCLC). , 2005, Annals of oncology : official journal of the European Society for Medical Oncology.

[150]  R. Damhuis,et al.  Resection rates and postoperative mortality in 7,899 patients with lung cancer. , 1996, The European respiratory journal.

[151]  R. Marasco,et al.  Oxygen desaturation during maximal stair-climbing test and postoperative complications after major lung resections. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[152]  Andrew K Stewart,et al.  Patterns of surgical care of lung cancer patients. , 2005, The Annals of thoracic surgery.

[153]  T. Iizasa,et al.  Minimal alteration of pulmonary function after lobectomy in lung cancer patients with chronic obstructive pulmonary disease. , 2003, The Annals of thoracic surgery.

[154]  J. Birkmeyer,et al.  Surgeon Specialty and Operative Mortality With Lung Resection , 2005, Annals of surgery.

[155]  A. Hofman,et al.  Complications of lung resection and exercise capacity: a meta-analysis. , 2007, Respiratory medicine.

[156]  V. Seshan,et al.  Incidence and risk factors for lung injury after lung cancer resection. , 2007, The Annals of thoracic surgery.

[157]  R. Dhand Aerosol therapy during mechanical ventilation: getting ready for prime time. , 2003, American journal of respiratory and critical care medicine.

[158]  E F Cook,et al.  Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. , 1999, Circulation.

[159]  M. Berry,et al.  Pulmonary function tests do not predict pulmonary complications after thoracoscopic lobectomy. , 2010, The Annals of thoracic surgery.

[160]  G. Silvestri,et al.  What happens to patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery. , 2002, Chest.

[161]  J. Tschopp,et al.  Operative mortality and respiratory complications after lung resection for cancer: impact of chronic obstructive pulmonary disease and time trends. , 2006, The Annals of thoracic surgery.

[162]  V. D. Di Crescenzo,et al.  Role of Diffusing Capacity in Predicting Complications after Lung Resection for Cancer , 2007, The Thoracic and cardiovascular surgeon.

[163]  G. Patterson,et al.  Lobectomy combined with volume reduction for patients with lung cancer and advanced emphysema. , 1998, The Journal of thoracic and cardiovascular surgery.

[164]  R. Garrod,et al.  Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: randomised controlled trial. , 2011, Lung cancer.

[165]  Robert J Cerfolio,et al.  Survival and outcomes of pulmonary resection for non-small cell lung cancer in the elderly: a nested case-control study. , 2006, The Annals of thoracic surgery.

[166]  C. Bolliger,et al.  Prediction of Functional Reserves after Lung Resection: Comparison between Quantitative Computed Tomography, Scintigraphy, and Anatomy , 2002, Respiration.

[167]  M. Kuskowski,et al.  Impact of preoperative smoking status on postoperative complication rates and pulmonary function test results 1-year following pulmonary resection for non-small cell lung cancer. , 2009, Lung cancer.

[168]  Kotaro Kameyama,et al.  Surgical treatment for non-small cell lung cancer in octogenarians--the usefulness of video-assisted thoracic surgery. , 2009, Interactive cardiovascular and thoracic surgery.

[169]  K. Marton,et al.  Indications for Pulmonary Function Testing , 1990 .

[170]  L. Voltolini,et al.  Short- and Long-Term Results of Lung Resection for Cancer in Octogenarians , 2009, Asian cardiovascular & thoracic annals.

[171]  P. Austin,et al.  Differences in operative mortality between high- and low-volume hospitals in Ontario for 5 major surgical procedures: estimating the number of lives potentially saved through regionalization. , 2003, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[172]  Mark K Ferguson,et al.  A comparison of three scoring systems for predicting complications after major lung resection. , 2003, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[173]  L. Koniaris,et al.  Impact of Teaching Facility Status and High-Volume Centers on Outcomes for Lung Cancer Resection: An Examination of 13,469 Surgical Patients , 2008, Annals of Surgical Oncology.

[174]  W. Vigneswaran,et al.  Diffusing capacity predicts morbidity after lung resection in patients without obstructive lung disease. , 2008, The Annals of thoracic surgery.

[175]  A. Chetta,et al.  Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[176]  R. Marasco,et al.  Predicted versus observed FEV1 in the immediate postoperative period after pulmonary lobectomy. , 2006, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[177]  D. Waller,et al.  Is the initial feasibility of lobectomy for stage I non-small cell lung cancer in severe heterogeneous emphysema justified by long-term survival? , 2007, Thorax.

[178]  Y. Mao,et al.  [Surgical treatment for lung cancer patients with poor pulmonary function]. , 2002, Zhonghua zhong liu za zhi [Chinese journal of oncology].

[179]  J. Austin,et al.  Incidental lung carcinoma detected at CT in patients selected for lung volume reduction surgery to treat severe pulmonary emphysema. , 1998, Radiology.

[180]  R. V. van Klaveren,et al.  Proper treatment selection may improve survival in patients with clinical early-stage nonsmall cell lung cancer. , 2005, The Annals of thoracic surgery.

[181]  G. Rocco,et al.  A model to predict the immediate postoperative FEV1 following major lung resections. , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[182]  G. Rocco,et al.  Measured FEV1 in the first postoperative day, and not ppoFEV1, is the best predictor of cardio-respiratory morbidity after lung resection. , 2007, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[183]  P. Pairolero,et al.  Lung cancer in octogenarians: factors affecting morbidity and mortality after pulmonary resection. , 2006, The Annals of thoracic surgery.

[184]  J. Hankinson,et al.  Standardisation of the single-breath determination of carbon monoxide uptake in the lung , 2005, European Respiratory Journal.

[185]  J. Birkmeyer,et al.  Effects of hospital volume on life expectancy after selected cancer operations in older adults: a decision analysis. , 2003, Journal of the American College of Surgeons.

[186]  J. Ornato,et al.  [ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery]. , 2009, Masui. The Japanese journal of anesthesiology.

[187]  D. Wigle,et al.  External validation of the recalibrated thoracic revised cardiac risk index for predicting the risk of major cardiac complications after lung resection. , 2011, The Annals of thoracic surgery.

[188]  B. Diggs,et al.  The influence of surgeon specialty on outcomes in general thoracic surgery: a national sample 1996 to 2005. , 2009, The Annals of thoracic surgery.

[189]  R. Marasco,et al.  A model to predict the decline of the forced expiratory volume in one second and the carbon monoxide lung diffusion capacity early after major lung resection. , 2005, Interactive cardiovascular and thoracic surgery.

[190]  M. Coory,et al.  Systematic review of multidisciplinary teams in the management of lung cancer. , 2008, Lung cancer.

[191]  G. Perna,et al.  Exercise-induced myocardial ischaemia detected by cardiopulmonary exercise testing. , 2003, European heart journal.

[192]  M. Socinski,et al.  Impact of preoperative chemotherapy on pulmonary function tests in resectable early-stage non-small cell lung cancer. , 2008, Chest.

[193]  Taofeek K Owonikoko,et al.  Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[194]  David R Hillman,et al.  Physiologic responses to incremental and self-paced exercise in COPD: a comparison of three tests. , 2004, Chest.

[195]  Jeroen J. Bax,et al.  A clinical randomized trial to evaluate the safety of a noninvasive approach in high-risk patients undergoing major vascular surgery: the DECREASE-V Pilot Study. , 2007, Journal of the American College of Cardiology.

[196]  P. Leblanc,et al.  Effects of lung resection on pulmonary function and exercise capacity. , 1990, Thorax.

[197]  A. Carretta,et al.  Does lobectomy for lung cancer in patients with chronic obstructive pulmonary disease affect lung function? A multicenter national study. , 2005, The Journal of thoracic and cardiovascular surgery.

[198]  S. Kitamura,et al.  Recovery and limitation of exercise capacity after lung resection for lung cancer. , 1998, Chest.

[199]  J. Birkmeyer,et al.  Hospital Volume and Surgical Mortality in the United States , 2002 .

[200]  V. Thourani,et al.  Preoperative risk assessment for marginal patients requiring pulmonary resection. , 2003, The Annals of thoracic surgery.

[201]  A. Brunelli,et al.  Predicted versus observed FEV1 and DLCO after major lung resection: a prospective evaluation at different postoperative periods. , 2007, The Annals of thoracic surgery.

[202]  J. Derose,et al.  Pulmonary nodule resection during lung volume reduction surgery. , 1997, AORN journal.

[203]  E. Touboul,et al.  Summary report of the Standards, Options and Recommendations for the management of patients with non-small-cell lung carcinoma (2000) , 2003, British Journal of Cancer.

[204]  Thomas E. Moritz,et al.  Coronary-artery revascularization before elective major vascular surgery. , 2004, The New England journal of medicine.

[205]  M. Argenziano,et al.  Lung reduction operation and resection of pulmonary nodules in patients with severe emphysema. , 1998, The Annals of thoracic surgery.

[206]  R. Johnson,et al.  Estimate of pulmonary diffusing capacity for oxygen during exercise in humans from routine O2 and CO2 measurements , 2004, Clinical physiology and functional imaging.

[207]  M. Ferguson Preoperative assessment of pulmonary risk. , 1999, Chest.

[208]  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.

[209]  S. Bettati,et al.  Exercise capacity assessment in patients undergoing lung resection. , 2009, European Journal of Cardio-Thoracic Surgery.

[210]  D. Galetta,et al.  Post-operative respiratory rehabilitation after lung resection for non-small cell lung cancer. , 2007, Lung cancer.

[211]  Surgical treatment for lung cancer patients with poor pulmonary function. , 2005, Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia.

[212]  H. Kuwano,et al.  Pulmonary function after pulmonary resection by posterior thoracotomy, anterior thoracotomy or video-assisted surgery. , 2010, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[213]  K. O'Byrne,et al.  The beneficial effects of specialist thoracic surgery on the resection rate for non-small-cell lung cancer. , 2004, Lung cancer.

[214]  Juned Siddique,et al.  Modeling major lung resection outcomes using classification trees and multiple imputation techniques. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[215]  C. Bolliger,et al.  Pulmonary function and exercise capacity after lung resection. , 1996, The European respiratory journal.

[216]  R. Abboud,et al.  Role of CO diffusing capacity during exercise in the preoperative evaluation for lung resection. , 2000, American journal of respiratory and critical care medicine.

[217]  J. Douketis,et al.  The perioperative management of antithrombotic therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). , 2008, Chest.

[218]  W. Hollingworth,et al.  Cost-Effectiveness of a Smoking Cessation Program Implemented at the Time of Surgery for Lung Cancer , 2009, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

[219]  Christina J. Herold,et al.  Consensus on medical treatment of non-small cell lung cancer. , 2002, Lung cancer.

[220]  C. Pompili,et al.  Recalibration of the revised cardiac risk index in lung resection candidates. , 2010, The Annals of thoracic surgery.

[221]  L. Voltolini,et al.  Long-term respiratory functional results after pneumonectomy. , 2008, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[222]  Therese A. Stukel,et al.  Hospital Volume and Late Survival After Cancer Surgery , 2007, Annals of surgery.

[223]  D. Flum,et al.  Surgeon specialty and long-term survival after pulmonary resection for lung cancer. , 2009, The Annals of thoracic surgery.

[224]  Denis Xavier,et al.  Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial , 2008, The Lancet.

[225]  P. Scanlon Assessment of operative risk in patients undergoing lung resection. Importance of predicted pulmonary function. , 1994, Chest.

[226]  R. Marasco,et al.  Inability to perform maximal stair climbing test before lung resection: a propensity score analysis on early outcome. , 2005, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[227]  C. Mountain,et al.  Regional and overall pulmonary function changes in lung cancer. Correlations with tumor stage, extent of pulmonary resection, and patient survival. , 1983, The Journal of thoracic and cardiovascular surgery.

[228]  C. Begg,et al.  The influence of hospital volume on survival after resection for lung cancer. , 2001, The New England journal of medicine.

[229]  C. Bolliger,et al.  Stair Climbing in the Functional Assessment of Lung Resection Candidates , 2008, Respiration.

[230]  C. Pompili,et al.  Peak Oxygen Consumption Measured during the Stair-Climbing Test in Lung Resection Candidates , 2010, Respiration.

[231]  S. Swanson,et al.  Treatment of patients with lung cancer and severe emphysema. , 1999, Chest.

[232]  T. Kohno,et al.  Video-assisted thoracic surgery for clinical stage I lung cancer in octogenarians. , 2008, The Annals of thoracic surgery.

[233]  M. S. Singh,et al.  Development of a shuttle walking test of disability in patients with chronic airways obstruction. , 1992, Thorax.

[234]  A. Carretta,et al.  Improvement of pulmonary function after lobectomy for non-small cell lung cancer in emphysematous patients. , 1999, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[235]  Kemp Kernstine,et al.  Preoperative Exercise Vo2 Measurement for Lung Resection Candidates: Results of Cancer and Leukemia Group B Protocol 9238 , 2007, Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer.

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

[237]  Frank C. Sciurba,et al.  Oxygen Consumption, Shuttle Walking Test and the Evaluation of Lung Resection , 2009, Respiration.

[238]  A. Mussi,et al.  Surgical treatment of non-small cell lung cancer in octogenarians. , 2011, Interactive cardiovascular and thoracic surgery.

[239]  A. Iwasaki,et al.  Surgical treatment for lung cancer with COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD). , 2005, The Thoracic and cardiovascular surgeon.

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

[241]  V. Rusch,et al.  Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. , 2006, The Annals of thoracic surgery.