[Evaluation of preoperative functional status in patients with lung cancer]

In view of the dismal prognosis of unresected bronchial cancer, surgical resection should be encouraged even in patients with borderline cardiopulmonary function. Accurate estimation of the cardiopulmonary reserve is therefore desirable to avoid denying potentially curative treatment on the on hand and severe postoperative disability on the other. Various parameters (lung volumes, gas exchange, pulmonary hemodynamics, exercise endurance) are reviewed concerning their predictive values to evaluate functional operatibility. No ideal test exists. During exercise both pulmonary and cardiac risk can be evaluated simultaneously. The high predictive value of maximal oxygen uptake to assess postoperative morbidity and mortality is established. The postoperative values for the forced expiratory volumes, the transfer factor, and maximal oxygen uptake can be predicted by means of quantitative lung scans. A new four-stage algorithm for the functional evaluation is presented. Patients with normal lung function and exercise electrocardiography can undergo lung resection up to a pneumonectomy without further diagnostic procedures. In others, first the predicted postoperative values of forced expiratory volume and transfer factor should be estimated by taking into account the number of segments to be resected. Patients with values < 30% predicted are regarded as inoperable, whereas values > 40% predicted quality for resection without the need for further diagnostics. Patients with values between 30-40% predicted are further differentiated with cardiopulmonary exercise testing and for those cases where diagnostic uncertainty still remains, predicted postoperative values can be calculated using quantitative lung scans.