Lobar occlusion in the preoperative assessment of patients with lung cancer

Bronchial occlusion during exercise was used to predict the functional effects of subsequent pulmonary resection in six high risk patients with lung cancer and severe airflow obstruction. Each patient underwent transnasal fibreoptic bronchoscopy whilst cycling in steady state at a load which had been selected as equivalent to walking at a brisk pace for that patient. The effects on minute ventilation and oxygen uptake were observed during occlusion of the bronchus to the diseased lobe. If the patient was able to continue cycling and maintain the same work load during occlusion this was regarded as indicating that he would withstand resection of the occluded lung tissue. In five of the patients, postoperative studies were performed. All were able to maintain the same level of steady state exercise postoperatively as that maintained during bronchial occlusion preoperatively. Resection resulted in a decrease in static lung volumes. Other routine whole lung function tests, walking capacity and incremental exercise indices, however, were largely unchanged.