[Comprehensive Preoperative Evaluation of Patients with Lung Cancer]

Area of Science:

• Oncology
• Thoracic Surgery
• Pulmonology

Background:

• Surgical resection is a primary curative treatment for non-small cell lung cancer (NSCLC) stages I-III and some small cell lung cancers.
• Complication and mortality rates after lung cancer surgery vary significantly, highlighting the need for careful patient selection.
• Individualized risk assessment is essential for determining surgical candidacy and the extent of resection possible.

Purpose of the Study:

• To outline a comprehensive preoperative evaluation protocol for lung cancer patients undergoing surgical resection.
• To emphasize the importance of risk stratification in optimizing surgical outcomes and patient selection.
• To guide physicians in discussing treatment risks and benefits with patients, considering their personal values and social context.

Main Methods:

• Evaluation includes Eastern Cooperative Oncology Group (ECOG) scoring, cardiac and cerebrovascular risk assessments.
• Pulmonary risk assessment involves split function analysis.
• For patients aged ≥70 years, Instrumental Activities of Daily Living (IADL) functional scoring is recommended.

Main Results:

• Risk stratification categorizes patients into three groups: low risk, increased risk, and typically not surgical candidates.
• The evaluation aims to identify appropriate surgical candidates and define the optimal extent of resection.
• Tailoring treatment based on individual risk profiles and patient preferences is key.

Conclusions:

• A thorough preoperative evaluation is vital for safe and effective surgical treatment of lung cancer.
• Risk stratification ensures that patients are offered the most appropriate treatment pathway, minimizing complications and mortality.
• Informed patient decision-making requires physicians to understand patient values, preferences, and social circumstances alongside medical data.