The most recent guidelines provide detailed algorithms for preoperative evaluation and preoperative risk assessment of lung resection candidates. There is no single gold standard test to predict the adequacy of post–resection lung function. Pulmonary evaluation includes “the three legged stool”: respiratory mechanics, pulmonary parenchymal and cardio-pulmonary function.
Keywords: preoperative evaluation, predictive postoperative forced expiratory volume in one second (ppoFEV1), cardiopulmonary exercise test (CPET), high-risk pulmonary patient.
In the past year, 667 patients ASA II-IV were operated in our department. Pulmonary resection was performed in 448/667 (67%) patients. After thoracic surgeon had decided types of lung resection, preoperative pulmonary function was evaluated. PpoFEV1 was less than 40% in 83/448 (19%) patients. CPET was performed in these patients. Ten patients were not capable of doing load exercise test. 64 out of 73 (88%) patients had maximum O2 uptake – VO2 max > 20 ml/kg/min, and 7/73(10%) patients had VO2max between 15-20 ml/kg/min. Only 2/73 (3%) patients had VO2 max less than 10 ml / kg / min and were contraindicated for lung resection surgery. 32/81 (40%) suffered from postoperative complications. 3/81 (4%) patients died because of respiratory failure and infections.
Today, the number of people with COPD and lung cancer is increasing, as well as the number of high-risk patients for lung cancer resection. Today, there are three great guidelines for preoperative evaluation for cancer resection (ERS/ESTS, BTS/SCTS and ACCP). These guidelines provide detailed algorithms for preoperative evaluation of resectable patients. Before the final evaluation, patients with poor lung function should be included in program of pulmonary rehabilitation and the bronchodilator therapy should be intensified. The biggest problem were the patients who have poor lung function and could not do load exercise tests. Our experience has shown that the majority of patients who had ppoFEV1<40% during CPET have achieved good results.
Preoperative evaluation shows the risks of the development of perioperative morbidity and mortality. The decision on operability of any border patient should be made by a multidisciplinary team including a surgeon, an anaesthesiologist and an oncologist.
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