Preoperative evaluation of the high-risk surgical patient for lung cancer resection

Surgery is the treatment of choice for patients with stage I or II non-small cell carcinoma of the lung. Many such patients will have concurrent chronic obstructive pulmonary disease, the presence of which may increase the risk of lung resection. Prediction of surgical morbidity and mortality related to impaired pulmonary physiology should be based on evaluation of physiological parameters. Such measurements can be derived from a variety of studies including pulmonary function testing, assessment of split lung function, and measurements of exercise capacity. While there does not exist uniform agreement about threshold levels of risk related to individual tests, judicious use of widely available physiological measurements including FEV1, DL (CO), and V (O2)max should enable clinicians to make reasonable assessments of operative risk. Because surgery is clearly optimal treatment for stages I and II non-small cell lung cancer, thoughtful consideration should be given to the decision of operability in each individual case.