Postoperative changes in pulmonary function testing and patient reported outcomes following lung resection: a review

Pulmonary resection is a primary treatment for patients with resectable non-small cell lung cancer, but removal of lung tissue can result in significant changes in postoperative pulmonary function and patient recovery. This review examines changes in pulmonary function tests (PFTs) and patient-reported outcomes following lung resection, with consideration of differences among surgical procedures and postoperative timepoints. Across studies, pulmonary function demonstrated its greatest decline during the early postoperative period, followed by gradual improvement during subsequent follow-up. However, pulmonary function generally remained below preoperative values, with the magnitude of decline influenced by the extent of lung tissue removed. Patients undergoing lobectomy or pneumonectomy generally experienced greater postoperative reductions than those undergoing sublobar procedures, although outcomes also varied according to the lobe and number of segments resected. Patient-reported outcomes, including dyspnea, pain, physical function, and quality of life, similarly worsened during early recovery but generally improved over time, with some measures returning to baseline. Preoperative pulmonary function, particularly DLCO, remains important for assessing a patient's ability to tolerate resection, while postoperative oxygen requirements are influenced by pulmonary function, patient characteristics, and postoperative complications. Additionally, decreased physical activity after surgery was associated with non-recovery of DLCO. Overall, postoperative pulmonary function follows a pattern of early decline followed by gradual recovery, although complete return to baseline is uncommon. These findings emphasize the importance of evaluating both pulmonary function and patient-reported outcomes when considering the consequences of pulmonary resection.