Preoperative evaluation of patients undergoing lung resection surgery

Lung cancer continues to be the leading case of cancer deaths in the United States. In patients with resectable non-small cell lung cancer, surgical resection is the treatment of choice. An accurate preoperative general and pulmonary-specific evaluation is essential as postoperative complications and morbidity of lung resection surgery are significant. After confirming anatomic resectability, patients must undergo a thorough evaluation to determine their ability to withstand the surgery and the loss of the resected lung. The measurement of spirometric indexes (ie, FEV1). , and diffusing capacity of the lung for carbon monoxide (DLCO) should be performed first. If FEV1 and DLCO are > 60% of predicted, patients are. at low risk for complications and can undergo pulmonary resection, including pneumonectomy, without further testing. However, if FEV1 and DLCO are < 60% of predicted, further evaluation by means of a quantitative lung scan is required. If lung scan reveals a predicted postoperative (ppo) values for FEV1 and DLCO of > 40%, the patient can undergo lung resection. If the ppo FEV1 and ppo DLCO are < 40%, exercise testing is necessary. if this reveals a maximal oxygen uptake (VO(2)max) of > 15 mL/kg, surgery can be undertaken. If the VO(2)max is < 15 mL/kg, surgery is not an option. This review discusses the existing, modalities for preoperative evaluation prior to lung resection surgery.