[Perioperative strategies for lung cancer patients with poor lung function]

The most important process in the treatment for lung cancer patients with poor lung function especially due to chronic obstructive pulmonary disease (COPD) is an adequate preoperative physiologic assessment to identify patients who are at increased risk for perioperative death and severe complications. Once the patient is assessed to not have increased risk for death after curative-intent surgery, he or she should be aggressively treated to achieve best possible baseline level of function. Preoperative treatments are the same as those for patients with COPD not preparing for surgery, which consist of smoking cessation, medication including bronchodilators, and pulmonary rehabilitation. The main part of recent pulmonary rehabilitation program for patients with COPD is exercise training. A few recent manuscripts demonstrated that short-term preoperative pulmonary rehabilitation including exercise training could improve exercise capacity of lung cancer patients with COPD and might have important implications for surgical outcome. Postoperative strategies to reduce pulmonary complications include adequate pain control with epidural analgesia, oral care, and airway clearance techniques (postural drainage, coughing, huffing, flutter breathing, percussion, vibration, and squeezing). To provide optimal surgical outcome for lung cancer patients with poor lung function, there is nothing but the accumulation of the fundamental treatments.