Preoperative Evaluation of the Lung Cancer Resection Candidate
Preoperative Evaluation of the Lung Cancer Resection Candidate
Anatomical lung resection offers the best chance of cure for patients with localized lung cancer. Many people who have lung cancer have additional comorbidities, including other lung problems. Lung resection will affect our patient's pulmonary function. When evaluating patients for lung resection we use measures of pulmonary function, predictions of postoperative lung function and measures of exercise capacity to determine their short- and long-term risks from resection. This article attempts to relate the evidence that is available regarding the physiologic evaluation of lung-resection candidates to guidelines that have been developed to help us coordinate our assessment. Testing algorithms are provided from these guidelines. In addition, perioperative considerations and alternative surgical approaches are discussed.
Surgical resection has the greatest chance of curing patients with localized lung cancer. Unfortunately, only 20–30% of individuals with lung cancer are found to be candidates for lung resection, owing to the stage of their disease or associated comorbidities. Many patients with lung cancer are elderly and have a history of cigarette use. Thus, those being evaluated for lung resection frequently have comorbidities. A report demonstrated that 37% of individuals who present with anatomically resectable disease are deemed not to be surgical candidates based on poor lung function alone. Understanding the prognosis without surgery, the expected early morbidity from lung resection and the potential loss of lung function related to the resection helps us to understand the importance of the preoperative pulmonary evaluation of lung resection candidates.
Abstract and Introduction
Abstract
Anatomical lung resection offers the best chance of cure for patients with localized lung cancer. Many people who have lung cancer have additional comorbidities, including other lung problems. Lung resection will affect our patient's pulmonary function. When evaluating patients for lung resection we use measures of pulmonary function, predictions of postoperative lung function and measures of exercise capacity to determine their short- and long-term risks from resection. This article attempts to relate the evidence that is available regarding the physiologic evaluation of lung-resection candidates to guidelines that have been developed to help us coordinate our assessment. Testing algorithms are provided from these guidelines. In addition, perioperative considerations and alternative surgical approaches are discussed.
Introduction
Surgical resection has the greatest chance of curing patients with localized lung cancer. Unfortunately, only 20–30% of individuals with lung cancer are found to be candidates for lung resection, owing to the stage of their disease or associated comorbidities. Many patients with lung cancer are elderly and have a history of cigarette use. Thus, those being evaluated for lung resection frequently have comorbidities. A report demonstrated that 37% of individuals who present with anatomically resectable disease are deemed not to be surgical candidates based on poor lung function alone. Understanding the prognosis without surgery, the expected early morbidity from lung resection and the potential loss of lung function related to the resection helps us to understand the importance of the preoperative pulmonary evaluation of lung resection candidates.