Preoperative Evaluation of the High-Risk Surgical Patient for Lung Cancer Resection

ABSTRACT

Surgery is the treatment of choice for patients with stage I or II non-small cell carcinoma of the lung. Many such patients will have concurrent chronic obstructive pulmonary disease, the presence of which may increase the risk of lung resection. Prediction of surgical morbidity and mortality related to impaired pulmonary physiology should be based on evaluation of physiological parameters. Such measurements can be derived from a variety of studies including pulmonary function testing, assessment of split lung function, and measurements of exercise capacity. While there does not exist uniform agreement about threshold levels of risk related to individual tests, judicious use of widely available physiological measurements including FEV1, DL_CO, and V_O2max should enable clinicians to make reasonable assessments of operative risk. Because surgery is clearly optimal treatment for stages I and II non-small cell lung cancer, thoughtful consideration should be given to the decision of operability in each individual case.

KEYWORD

Lung cancer - postoperative complications - pulmonary function tests - exercise testing

REFERENCES

• 1 American Cancer Society. Cancer Facts and Figures. 2000.
• 2 American College of Physicians. Preoperative Pulmonary Function Testing.  Ann Int Med . 1990;  112 793-794
• 3 Gaensler E, Cugell D, Lindgren I, Verstraeten J, Smith S, Strieder J. The role of pulmonary insufficiency in mortality and invalidism following surgery for pulmonary tuberculosis.  J Thorac Surg . 1955;  29 163-187
• 4 Mittman C. Assessment of operative risk in thoracic surgery.  Am Rev Respir Dis . 1961;  84 197-207
• 5 Boushy S, Billig D, North D, Helgason A. Clinical course related to preoperative and postoperative pulmonary function in patients with bronchogenic carcinoma.  Chest . 1971;  59 383-391
• 6 Weiss W, Cooper D, Boncot K. Operative mortality in five year survival rates in men with bronchogenic carcinoma.  Ann Int Med . 1969;  71 59-65
• 7 Wernly J, DeMeester T, Kirchner P, Myerowitz P, Oxford D, Golomb H. Clinical value of quantitative ventilation perfusion lung scans in the surgical management of bronchogenic carcinoma.  J Thorac Cardiovasc Surg . 1980;  80 535-543
• 8 Miller J. Physiologic evaluation of pulmonary function in the candidate for lung resection.  J Thorac Cardiovasc Surg . 1993;  105 347-352
• 9 Nagasaki F, Flehinger B, Martini N. Complications of surgery in the treatment of carcinoma of the lung.  Chest . 1982;  82 25-29
• 10 Olsen G, Block A, Swenson E, Castle J, Wynne J. Pulmonary function evaluation of the lung resection candidate: A prospective study.  Am Rev Respir Dis . 1975;  111 379-387
• 11 Mittman C, Bruderman I. Lung cancer: To operate or not.  Am Rev Respir Dis . 1977;  116 477-496
• 12 Bolliger C, Soler M, Stul P. Evaluation of high-risk lung resection candidates: Pulmonary haemodynamics versus exercise testing.  Respiration . 1994;  61 181-186
• 13 Kearney D, Lee T, Reilly J, DeCamp M, Sugarbaker D. Assessment of operative risk in patients undergoing lung resection.  Chest . 1994;  105 753-759
• 14 Jacobaeus H, Frenckner P, Bjorkman S. Some attempts at determining the volume and function of each lung separately.  Acta Med Scand . 1932;  79 174-215
• 15 Bergan F. A simple method for determinations of the relative functions of the right and left lung.  Acta Chir Scan . 1960;  253 S58-S63
• 16 Carlens E, Hanson H, Nordenstrom B. Temporary unilateral occlusion of the pulmonary artery.  J Thorac Surg . 1951;  22 527-536
• 17 Uggla L. Indications for and results of thoracic surgery with regard to respiratory and circulatory function tests.  Acta Clin Scand . 1956;  111 196-212
• 18 Suzuki C, Arakaki Y, Najorolima Y. Resection tolerance of the patients with lung cancer associated with chronic obstructive pulmonary disease.  Sci Rep Res Inst Tohoku Univ . 1970;  17 60-64
• 19 Taube K, Konietzko N. Prediction of postoperative cardiopulmonary function in patients undergoing pneumonectomy.  Thorac Cardiovasc Surg . 1980;  28 348-351
• 20 Loddenkemper R, Gabler A, Gobel D. Criteria of functional operability in patients with bronchial carcinoma: Preoperative assessment of risk and prediction of postoperative function.  Thorac Cardiovasc Surg . 1983;  31 334-336
• 21 Olsen G, Weiman D, Bolton J. Submaximal invasive exercise testing and quantitative lung scanning in the evaluation for tolerance of lung resection.  Chest . 1989;  95 267-273
• 22 Miorner G. 133xe-radiospirometry. A clinical method for studying regional lung function.  Scand J Respir Dis . 1968;  S64
• 23 Kristersson S, Lindell S, Svanberg L. Prediction of pulmonary function loss due to pneumonectomy using 133Xe-radiospirometry.  Chest . 1972;  62 694-698
• 24 Tonnesen K, Dige-Petersen H, Lund J. Lung split function test and pneumonectomy.  Scand J Thorac Cardiovas Surg . 1978;  12 133-136
• 25 Ali M, Mountain C, Ewer M, Johnston D, Haynie T. Predicting loss of pulmonary function after pulmonary resection for bronchogenic carcinoma.  Chest . 1980;  77 337-342
• 26 Ellis D, Hawkins T, Gibson G, Nariman S. Role of lung scanning in assessing the resectability of bronchial carcinoma.  Thorax . 1983;  38 261-266
• 27 Markos J, Mullan B, Hillman D. Preoperative assessment of mortality and morbidity after lung resection.  Am Rev Respir Dis . 1989;  139 902-910
• 28 Corris P, Ellis D, Hawkins T, Gibson G. Use of radionuclide scanning in the preoperative estimation of pulmonary function after pneumonectomy.  Thorax . 1987;  42 285-291
• 29 Gass G, Olsen G. Preoperative pulmonary function testing to predict postoperative morbidity and mortality.  Chest . 1986;  89 127-135
• 30 Segall J, Butterworth B. Ventilatory capacity in chronic bronchitis in relation to carbon dioxide production.  Scan J Respir Dis . 1966;  47 215-224
• 31 Pate P, Tenholder M, Griffin J, Eastridge C, Weiman D. Preoperative assessment of the high-risk patient for lung resection.  Ann Thorac Surg . 1996;  61 1494-1500
• 32 Ferguson M, Little L, Rizzo L. Diffusing capacity predicts morbidity and mortality after pulmonary resection.  J Thorac Cardiovasc Surg . 1988;  96 894-900
• 33 Cander L. Physiologic assessment and management of the preoperative patient with pulmonary emphysema.  Am J Cardiol . 1963;  12 324-326
• 34 Van Nostrand D, Kjelsberg M, Humphrey E. Pre-resectional evaluation of risk from pneumonectomy.  Surg Gynecol Obstet . 1968;  127 306-312
• 35 Holden B, Rice T, Stelmach K, Meker D. Exercise testing, six minute walk and stair climb in the evaluation of patients at high risk of pulmonary resection.  Chest . 1992;  102 1774-1779
• 36 Olsen G, Bolton J, Weiman D, Hornung C. Stair climbing as an exercise test to predict the postoperative complications of lung resection.  Chest . 1991;  99 587-590
• 37 Bolton J, Weiman D, Haynes J, Hornung C, Olsen G, Amand C. Stair climbing as an indicator of pulmonary function.  Chest . 1987;  92 783-787
• 38 Pollock M, Roa J, Benditt J, Celli B. Estimation of ventilatory reserve by stair climbing. A study in patients with chronic air flow obstruction.  Chest . 1993;  104 1378-1383
• 39 Eugene J, Brown S, Light R, Milne N, Stemmer E. Maximum oxygen consumption: A physiologic guide to pulmonary resection.  Surg Forum . 1982;  33 260-262
• 40 Smith T, Kinasewitz G, Tucker W, Spillers W, George R. Exercise capacity as a predictor of post-thoracotomy morbidity.  Am Rev Respir Dis . 1984;  129 730-734
• 41 Bechard D, Wetstein L. Assessment of exercise oxygen consumption as preoperative criterion for lung resection.  Ann Thorac Surg . 1987;  44 344-349
• 42 Epstein S, Saling L, Daly B, Celli B. Predicting complications after pulmonary resection: Preoperative exercise testing versus a multifactorial cardiopulmonary risk index.  Chest . 1993;  104 694-700
• 43 Coleman N, Schraufnagel D, Rivington R, Pardy R. Exercise testing in evaluation of patients for lung resection.  Am Rev Respir Dis . 1982;  125 604-606
• 44 Bolliger C, Jordan P, Soler M. Exercise capacity as predictor of postoperative complications in lung resection candidates.  Am J Respir Crit Care Med . 1995;  151 1472-1480
• 45 Puente-Maestu L, De Lucas P, Amedillo A, Calle M, Tatai E, Monturiol M. Prediction of maximal oxygen uptake after thoracic surgery by radionuclide perfusion scanning.  Am Rev Respir Dis . 1994;  149 A785
• 46 Bolliger C, Wyser C, Roser H, Soler M, Perruchoud A. Lung scanning and exercise testing for the prediction of postoperative performance in lung resection candidates at increased risk for complications.  Chest . 1995;  108 341-348
• 47 Bolliger C, Jordan P, Soler M. Pulmonary function and exercise capacity after lung resection.  Eur Respir J . 1996;  9 415-421
• 48 Nezu K, Kushibe K, Tojo T, Takahama M, Kitamura S. Recovery and limitation of exercise capacity after lung resection for lung cancer.  Chest . 1998;  113 1511-1516
• 49 Morice R, Peters E, Ryan M, Putnam J, Ali M, Roth J. Exercise testing in the evaluation of patients at high risk for complications from lung resection.  Chest . 1992;  101 356-361
• 50 Wyser C, Stulz P, Soler M. Prospective evaluation of an algorithm for the functional assessment of lung resection candidates.  Am J Respir Crit Care Med . 1999;  159 1450-1456
• 51 Brantigan O, Mueller E. Surgical treatment of pulmonary emphysema.  Ann Surg . 1957;  23 789-804
• 52 Cooper J, Trulock E, Triantafillou A. Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease.  J Thorac Cardiovasc Surg . 1995;  109 106-119
• 53 Ojo T, Martinez F, Paine R. Lung volume reduction surgery alters management of pulmonary nodules in patients with severe COPD.  Chest . 1997;  112 1494-1500
• 54 McKenna R, Fischel R, Brenner M, Gelb A. Combined operations for lung volume reduction surgery and lung cancer.  Chest . 1996;  110 885-888
• 55 Shields T. Surgical therapy for carcinoma of the lung.  Clinics Chest Med . 1993;  14 121-148
• 56 Bolliger C, Perruchoud A. Functional evaluation of the lung resection candidate.  Eur Respir J . 1998;  11 198-212
• 57 Olsen G. Lung cancer resection: Who's inoperable?.  Chest . 1995;  108 298-29