Preoperative evaluation of the patient with lung cancer being considered for lung resection

This review summarizes the general approach to evaluating the cardiopulmonary fitness of a patient with lung cancer being considered for lung resection. Many patients have a high risk for morbidity and mortality from lung resection owing to severe comorbidities or low cardiopulmonary reserve. A comprehensive and individualized assessment is essential to identify the factors that may impact operative outcome.

Identification of comorbid conditions related to cigarette smoking, particularly cardiovascular diseases, is essential because they need to be managed in advance. In those with low predicted postoperative forced expiratory volume during first second (FEV(1)) or carbon monoxide diffusing capacity (DL(CO)), or impaired performance on a low-technology exercise test, cardiopulmonary exercise testing should be considered.

Preoperative assessment requires an understanding of the relative benefits and harms of available treatment options and consideration of patients' values. A balance between the potential to cure one's cancer and the short-term and long-term risks of the selected treatment needs to be reached. All patients should have a baseline FEV(1) and DL(CO) measured, and predicted postoperative FEV(1) and DL(CO) calculated to assist with risk prediction. Measures of exercise performance can help to further risk stratify patients. Means of modifying the risks should be considered for all patients.