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Risk Stratification in Lung Resection.

Michele Salati¹, Alessandro Brunelli²

¹Division of Thoracic Surgery, Ospedali Riuniti Ancona, Via Conca 1, 60020 Ancona, Italy.

Current Surgery Reports

|October 13, 2016

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Preoperative assessment for lung cancer surgery involves cardiac evaluation and pulmonary function tests. A simplified algorithm using forced expiratory volume, diffusion capacity, and exercise testing helps stratify surgical risk for patients.

Area of Science:

Cardiopulmonary Medicine
Thoracic Surgery
Oncology

Background:

Lung resection is the primary treatment for early-stage lung cancer.
Pulmonary complications post-lung resection can be severe and life-threatening.
Accurate preoperative functional assessment is crucial for patient safety.

Approach:

Review of current evidence on preoperative risk evaluation for lung resection.
Development of a practical algorithm for functional assessment.
Integration of cardiac risk, pulmonary function tests, and exercise testing.

Key Points:

Cardiac risk assessment is the initial step.
Predicted postoperative values for forced expiratory volume in one second (FEV1) and carbon monoxide lung diffusion capacity (DLCO) >60% indicate low risk.

Keywords:

Cardiac risk Co-morbidities Exercise test Lung cancer surgery Lung resection Morbidity Mortality Operative Risk Preoperative evaluation Pulmonary function

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Cardiopulmonary exercise testing (CPET) is recommended for FEV1 or DLCO <60%, with VO2max >20 mL/kg/min suggesting low risk and VO2max <10 mL/kg/min indicating high risk.

Conclusions:

Cardiologic evaluation, pulmonary function tests (including DLCO), and CPET are essential for preoperative assessment.
A simplified algorithm aids in stratifying surgical risk for lung resection candidates.
This approach optimizes patient selection and management for lung cancer surgery.