Cardiopulmonary exercise testing in the preoperative assessment for lung resection surgery

Whereas pulmonary function tests (PFTs) initially identify high-risk pulmonary patients being evaluated for lung resection surgery, other diagnostic modalities, including cardiopulmonary exercise testing (CPET) and/or split function studies, are then necessary for a more accurate assessment. CPET including VO2max have emerged as integral components of a step approach for the physiologic assessment for lung resection surgery. Increasingly, CPET is being used because it provides the best index of functional capacity and global O2 transport (VO2max) as well as estimating both cardiac and pulmonary reserves not available from other modalities. CPET permits the detection of clinically occult heart disease and provides a more reliable estimate of functional capacity postoperatively compared with PFTs, which routinely overestimate functional loss after lung resection. Currently, though split function studies are clearly established and have traditionally been used before CPET in preoperative decision analysis, recent work favors using CPET including VO2max before split function studies because VO2max % predicted is a good independent predictor of risk. Importantly, both studies are complementary and optimize assessment of surgical risk; this is particularly valuable for borderline patients, so that opportunity for curative resection is not denied.