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Updated: Jun 9, 2026

Non-Intubated Video-Assisted Thoracoscopic Surgery
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Published on: May 26, 2023

Risk assessment for pulmonary resection.

Alessandro Brunelli1

  • 1Division of Thoracic Surgery, Ospedali Riuniti, Ancona, Italy.

Seminars in Thoracic and Cardiovascular Surgery
|September 4, 2010
PubMed
Summary
This summary is machine-generated.

Pulmonary resection requires cardiac risk assessment. Exercise testing, not just predicted FEV1, is crucial for evaluating lung surgery candidates, especially those with COPD.

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Area of Science:

  • Cardiology
  • Pulmonology
  • Thoracic Surgery

Background:

  • Pulmonary resection necessitates careful pre-operative risk stratification.
  • Cardiac risk assessment is a critical first step in evaluating patients for lung surgery.

Purpose of the Study:

  • To outline a comprehensive risk assessment strategy for patients undergoing pulmonary resection.
  • To emphasize the importance of exercise testing over predicted FEV1 for surgical candidacy.

Main Methods:

  • Cardiac evaluation followed by pulmonary assessment.
  • Measurement of lung carbon monoxide diffusing capacity.
  • Utilizing exercise testing, including stair-climbing tests and formal cardiopulmonary exercise testing (CPET) with Vo(2max) measurement.

Main Results:

  • Patients with prohibitive cardiac risk require guideline-directed evaluation and treatment.
  • Predicted postoperative forced expiratory volume in 1 second (FEV1) is an unreliable predictor of complications, particularly in COPD patients.
  • Low-technology tests like stair climbing can guide referral for formal CPET.
  • A Vo(2max) < 10 mL/kg/min or <35% predicted indicates high risk for major lung resection.

Conclusions:

  • A multi-faceted approach combining cardiac and pulmonary evaluations, with an emphasis on exercise testing, is essential for safe pulmonary resection.
  • Formal cardiopulmonary exercise testing is recommended for a precise assessment of aerobic reserve in high-risk individuals.