[The importance of exercise testing for the functional assessment of lung resectional candidates]

Although there are a lot of physiologic tests to evaluate the preoperative cardio-pulmonary reserve in the patients who candidate lung resection, there is no a single gold standard test to suggest the postoperative pulmonary complications. In this study, we researched the importance of the exercise testing in the evaluation preoperative cardio-pulmonary reserve. We analyzed a series of 26 consecutive patients with a resectable lung disease [26 male patients, mean age 51.5 +/- 15.8 (13-78 years), 22 non-small cell lung carcinoma (NSCLC), 2 bronchectasis, 1 hydatid cyst, 1 empyema]. Patients were evaluated by pulmonary function testing (PFT), diffusing capacity of lung for carbonmonoxide (DLCO), and symptom-limited exercise testing. After the functional examination, 26 patients underwent pulmonary resections with standard thoracotomy: 4 segmental or wedge resection, 11 lobectomies, 5 pneumonectomies, and 1 cystotomia. The mean stay in the ICU was 2.6 days (+/- 3.5), the mean hospital stay was 11.9 days (+/- 8.0). Postoperative complications (within 30 days) occurred in 9 (34.6%) patients of whom one died (overall mortality rate was 3.8%). There was no relationship between the presence of complication and physiologic tests (PFT, DLCO). The patients were divided three groups according to peak oxygen consumption (VO(2)/kg peak) (mL/kg/min) (< 10, 10-20, > 20 mL/kg/min). There was no significantly difference among these groups and complication rates (p= 0.056), but the complication rate was higher in the group of VO(2)/kg peak < 10 mL/kg/min (75%). On the other hand, there was a significantly relationship between the presence of only pulmonary complication and VO2/kg peak (p= 0.034).

We think that the preoperative functional evaluation in the patients with lung resection candidate is prominent to reduce the postoperative mortality and morbidity and especially cardiopulmonary exercise testing has an important role to suggest the postoperative pulmonary complications as a major complication.