Pulmonary function prediction in lung cancer resection candidates: the latest insights

Surgical resection remains the most effective curative option for early-stage nonsmall cell lung cancer (NSCLC) in fit patients. However, many individuals with NSCLC have comorbidities that elevate surgical risks and complicate postoperative recovery. These challenges necessitate thorough preoperative assessments to evaluate patient suitability and predict postoperative lung function. Pulmonary function tests (PFTs) and imaging modalities, including computed tomography (CT), ventilation-perfusion scintigraphy and ultrasound, are integral to these evaluations. Advances in technology, such as ventilation and perfusion single-photon emission computed tomography (SPECT)/CT, quantitative CT and magnetic resonance imaging (MRI) techniques, have enhanced the accuracy of postoperative predictions, offering valuable insights into respiratory mechanics and regional lung function. Despite these advancements, no comprehensive evaluation exists to establish the reliability of various prediction methods. This review explores the role of traditional and emerging preoperative tools in assessing lung resection candidates, emphasising their contributions to clinical decision-making. By improving the precision of postoperative lung function predictions, these tools not only optimise surgical outcomes but also support shared decision-making, balancing risks and patient preferences. Further refinement and integration of these methods promises to enhance the management of high-risk patients and advance the standard of care in thoracic surgery.