Future trends in preoperative evaluation.

Area of Science:

• Pulmonary Medicine
• Thoracic Surgery
• Cardiorespiratory Physiology

Background:

• Preoperative evaluation for lung resection often relies on predicted pulmonary volumes.
• Post-predicted forced expiratory volume in 1 second (pplFEV1) may underestimate immediate postoperative functional loss.
• Individual functional changes after lobectomy vary, with some COPD patients showing minimal impairment or improvement.

Purpose of the Study:

• To emphasize the need for accurate prediction of immediate postoperative pulmonary volumes.
• To highlight the importance of assessing a patient's overall cardiorespiratory status.
• To identify high-risk patients for lung resection more effectively.

Main Methods:

• Reviewing current literature on preoperative evaluation for lung resection.
• Discussing the limitations of traditional pulmonary function tests like pplFEV1.
• Suggesting the incorporation of preoperative diffusing capacity of the lungs for carbon monoxide (DLCO) measurements (rest and exercise) and daily activity monitoring.

Main Results:

• pplFEV1 is insufficient for predicting immediate postoperative complications.
• Preoperative DLCO and general cardiorespiratory status are vital for assessing surgical risk.
• Exercise tests and activity monitoring can identify high-risk patients with seemingly acceptable pulmonary volumes.

Conclusions:

• Accurate prediction of postoperative pulmonary volumes is essential for evaluating high-risk patients.
• Further research is needed on the role of DLCO and comprehensive cardiorespiratory assessment.
• Multidisciplinary approaches and large databases are crucial for developing evidence-based guidelines for preoperative evaluation.