Related Experiment Videos
Lung resection in the pulmonary-compromised patient
1Division of Thoracic Surgery, Department of Surgery, Centre Hospitalier de l'Université de Montreal, 1560 Sherbrooke Street East, Suite D-8051, Montréal, Quebec, Canada. jocelyne.martin@umontreal.ca
Thoracic Surgery Clinics
|September 24, 2004
Summary
Preoperative pulmonary function testing is crucial for lung resection candidates. A combination of tests, not a single criterion, helps select patients who will benefit from surgery.
Area of Science:
- Pulmonology
- Thoracic Surgery
- Cardiopulmonary Physiology
Background:
- Lung resection requires careful patient selection to minimize postoperative complications.
- Preoperative assessment of pulmonary function is essential for determining surgical candidacy.
Purpose of the Study:
- To outline the essential preoperative pulmonary function tests for patients undergoing lung resection.
- To emphasize the importance of a multimodal approach in assessing surgical risk.
Main Methods:
- Pulmonary function testing (PFTs), including forced expiratory volume in 1 second percentage (FEV1%).
- Quantitative radionuclide perfusion scanning for patients with reduced FEV1%.
- Exercise testing (VO2max) for high-risk individuals.
Main Results:
- A FEV1% of 60%-70% or less warrants further investigation with perfusion scanning.
- A predicted postoperative FEV1% (ppoFEV1%) around 40% indicates higher complication risk and may require exercise testing.
- VO2max values below 10-15 ml/kg/min or ppoVO2max less than 10 ml/kg/min are generally prohibitive for surgery.
Conclusions:
- No single test should exclude a patient from lung resection; multiple preoperative studies are necessary.
- Selected high-risk patients may benefit from alternative surgical interventions, including lung volume reduction surgery.
- Careful patient selection using comprehensive preoperative evaluation can enable safe pulmonary resection even in previously inoperable cases.