Lung Cancer: Preoperative Pulmonary Evaluation of the Lung Resection Candidate

Abstract

Lung resection provides the best chance of cure for individuals with early-stage non-small-cell lung cancer. Lung resection will lead to a decrease in lung function. The population that develops lung cancer often has concomitant lung disease and a reduced ability to tolerate further losses in lung function. The goal of the preoperative pulmonary assessment of individuals with resectable lung cancer is to identify those individuals whose short- and long-term morbidity and mortality would be unacceptably high if surgical resection were to occur. Pulmonary function measures such as the forced expiratory volume in 1 second (FEV1) and the diffusing capacity for carbon monoxide (DLCO) are useful predictors of postoperative outcome. When lung function in not normal, the prediction of postoperative lung function from preoperative results, and the assessment of exercise capacity, can help to clarify the risks. Testing algorithms and published guidelines help to direct the order of testing. Interventions that allow us to consider resection outside of the guidelines, or to maximize the potential to tolerate lung resection, help us to offer potentially curative treatment to as many as possible. Knowledge of alternative treatment options will help to guide those deemed unfit for resection.

Prediction of the postoperative pulmonary function in lung cancer patients with borderline function using ventilation–perfusion scintigraphy

“…Otherwise, evaluation of residual lung function should be performed [14,15]. In our study, all patients' FEV 1 values were less than the threshold values (2.0 l for pneumonectomy or 1.5 l for lobectomy).…”

Radiomics in Lung Cancer from Basic to Advanced: Current Status and Future Directions

“…The prediction of postoperative lung function is mandatory in the preoperative evaluation of lung cancer patients, especially in those with reduced lung function (14). The current standard for predicting postoperative lung function uses spirometry, such as forced expiratory volume in one second, and diffusing capacity of the lung for carbon monoxide or radionuclide lung scanning (15). In much earlier research, Wu et al (16) used quantitative CT and found that it correlated well with postoperative lung function in patients with lung cancer.…”

CT Radiomics in Thoracic Oncology: Technique and Clinical Applications

“…Prediction of postoperative lung function plays a key role in the preoperative evaluation of lung cancer patients with impaired lung function in order to identify an increased risk of postoperative complication and mortality [43]. Currently, postoperative lung function is predicted using spirometry, including forced expiratory volume in 1 s and diffusing capacity for carbon monoxide, and radionuclide lung scanning [44]. An accurate prediction of postoperative pulmonary function is considered for conditions with inhomogeneous effective pulmonary function such as pulmonary emphysema or interstitial lung disease (ILD) [45].…”