Lung resection in the pulmonary-compromised patient

Every patient evaluated for lung resection should have preoperative pulmonary function testing. Patients with a significant decrease in FEV1% (approximately 60%-70% or less) should have a quantitative radionuclide perfusion scanning. Patients with a low ppoFEV1% (approximately 40%) should be considered for exercise testing because their risk for developing postoperative complications is higher. A VO2max between 10 to 15 ml/kg/minute or a ppoVO2max of less than 10 ml/kg/minute would usually be considered prohibitive for surgery. Nevertheless, no single criterion should be used to exclude a patient from surgery. Rather, the use of multiple preoperative studies is needed to select patients who will tolerate and benefit from pulmonary resection. Surgical interventions other than standard lobectomies or pneumonectomies can be offered to selected high-risk patients. Experience from lung volume reduction surgery has shown that some patients who would have been considered inoperable can safely undergo resection of their lung cancer.