Submaximal Invasive Exercise Testing and Quantitative Lung Scanning in the Evaluation for Tolerance of Lung Resection

Olsen, Gerald N.; Weiman, Darryl S.; Bolton, Joe W.R.; Gass, G. David; McLain, William C.; Schoonover, G. A.; Hornung, Carlton A.

doi:10.1378/chest.95.2.267

Cited by 110 publications

(41 citation statements)

References 13 publications

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“…The value of FEV1-ppo to predict postoperative complications has received increasing attention in recent publications. OLSEN et al [73] did not find it predictive, whereas KEARNEY et al [41], in a large prospective study involving 331 patients, found the FEV1-ppo the only independent predictor of postoperative complications.…”

Section: Split-function Studiesmentioning

confidence: 92%

“…LODDENKEMPER et al [16] did not find the Ppa on exercise predictive up to a value of 45 mmHg. OLSEN et al [73] found neither Ppa nor the calculated pulmonary vascular resistance (PVR) on submaximal exercise predictive of postoperative complications. The latter finding is in contrast to an early, often cited report by FEE et al [56], who found a PVR of <190 dyn·s·cm -5 at rest or on exercise a criterion of operability (table 1).…”

Section: Pulmonary Haemodynamicsmentioning

confidence: 99%

“…OLSEN et al [73] studied 29 patients with pulmonary artery catheters on cycle ergometry at workloads of 25 and 40 W during 2-4 min. The 22 survivors were best separated from the seven nonsurvivors by the cardiac index (5.5±1.3 vs 3.9±0.3 L·min -1 ·m -2 ), O 2 delivery (1,630±462 vs 1070±95 mL·min -1 ·m -2 ) and calculated V 'O 2 (11.3±2.1 vs 7.8±1.5 mL·kg -1 ·min -1 ).…”

Section: Submaximal Testsmentioning

confidence: 99%

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Functional evaluation of the lung resection candidate

Bolliger¹,

Perruchoud²

1998

Eur Respir J

163

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Advances in operative technique and perioperative care have considerably reduced surgical morbidity and mortality after pulmonary resections. Various single and combined parameters of functional operability have been proposed to assess the surgical risk. Pulmonary function tests adequately assess the pulmonary risk, and baseline or stress electrocardiography, echocardiography and nuclear cardiac studies assess the cardiac risk.Patients with normal or only slightly impaired pulmonary function (forced expiratory volume in one second (FEV1) and transfer factor of the lung for carbon monoxide (TL,CO) ≥80% of predicted) and no cardiovascular risk factors can undergo pulmonary resections up to a pneumonectomy without further investigation. For others, exercise testing, pulmonary split-function studies, or a combination of these two methods are recommended. Exercise testing, most frequently performed as a symptom-limited test with the measurement of maximal oxygen uptake (V 'O 2 ,max), assesses both the pulmonary and cardiovascular reserves. A V'O 2 ,max of <10 mL·kg -1 ·min -1 is generally considered prohibitive for any resection, a value of >20 mL·kg -1 ·min -1 or >75% of predicted normal, safe for major resections. Split-function studies are radionuclide-based estimations of the predicted postoperative (ppo) values of various parameters. The currently used ppo-parameters are FEV1-ppo, TL,CO-ppo and, most recently, V'O 2 ,max-ppo. Suggested cutoff values for safe resection are: for FEV1-ppo and TL,CO-ppo ≥40% pred; and for V 'O 2 ,max ≥35% pred, combined with an absolute value of ≥10 mL·kg -1 ·min -1 . The lowest acceptable ppo-values will still have to be established by additional prospective studies.In the long-term, resections involving not more than one lobe usually lead to an early functional deficit followed by later recovery. The permanent functional loss in pulmonary function is small (≤10%) and exercise capacity is only slightly reduced or not at all. Pneumonectomy, on the other hand, leads to an early permanent loss of about 33% in pulmonary function and 20% in exercise capacity. Thus, pulmonary function tests alone overestimate the functional loss after lung resection. Eur Respir J 1998; 11: 198-212 The dramatic increase in the incidence of bronchogenic carcinoma has made this disease the most frequent malignancy worldwide. In industrialized nations, the majority of lung resection candidates suffer from bronchogenic carcinoma, whereas only some decades ago benign conditions, such as destroyed lung parenchyma after tuberculosis, had to be removed. The prognosis of bronchogenic carcinoma remains sombre as about 75-85% are inoperable at the time of diagnosis [1], and despite recent advances in chemo-and radiotherapy regimens, surgical resection remains the only curative form of treatment [2].Depending on their extent, pulmonary resections lead to permanent loss of pulmonary function. In healthy people, resections up to a pneumonectomy are tolerated remarkably well. Lung cancer patients, however, are...

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Section: Split-function Studiesmentioning

confidence: 92%

Section: Pulmonary Haemodynamicsmentioning

confidence: 99%

Section: Submaximal Testsmentioning

confidence: 99%

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Functional evaluation of the lung resection candidate

Bolliger¹,

Perruchoud²

1998

Eur Respir J

163

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“…On the contrary, the risk of perioperative death sharply increases below the level of VO2max < 15 mL/kg/min Win, et al 2005). VO2max < 10 mL/kg/min has been reported as a very high risk of postoperative death (Holden, et al 1992;Olsen, et al 1989). …”

Section: Lung Function Testmentioning

confidence: 99%

Prediction of Postoperative Lung Function

Jang¹

2012

Topics in Cancer Survivorship

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“…Lung function tests, such as determination of forced expiratory volume in one second (FEV1), vital capacity, airway or pulmonary vascular resistances, carbon monoxide diffusing capacity of the lung (DL,CO) and resting arterial blood gas, are not always sufficient to define precisely the "functional operability" of a patient [1][2][3][4][5][6]. In other words, except for very deteriorated or normal lung function, standard tests are not sensitive enough to differentiate between patients who could support a limited resection or a pneumonectomy [4][5][6].…”

mentioning

confidence: 99%

Effect of exercise on lung-perfusion scanning in patients with bronchogenic carcinoma

Chenuel¹,

Haouzi²,

Pellegrini³

et al. 2002

Eur Respir J

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The aim of this study was to determine whether perfusion-scintillation scanning, used as a predictive pre-operative index of lung functionality in patients with lung cancer, is affected by the level of pulmonary blood flow (PBF).Twenty patients with primary lung cancer underwent spirometry and a radionuclideperfusion scan (macroaggregated albumin particles labelled with 99m Technetium) both at rest and during the last minute of a ramp-like increase in work rate until exhaustion.On average, the perfusion of the lung with the tumour was significantly reduced by the same magnitude at rest and during exercise (mean ¡ SD: -9 ¡ 6% versus -10 ¡ 4% of the cardiac output), regardless of the extent of the tumour. However, subject-by-subject analysis revealed that in two patients, a larger decrease in the perfusion of the lung with the tumour was observed during exercise than at rest (-11% and -17%, respectively). This leads to an underestimation of predictive postoperative functional parameters if resting values are used in these patients.The use of perfusion scintigraphy at rest therefore gives a clear picture of the functionality of the lung before resection in most patients requiring surgery. Eur Respir J 2002; 20: 710-716.

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Submaximal Invasive Exercise Testing and Quantitative Lung Scanning in the Evaluation for Tolerance of Lung Resection

Cited by 110 publications

References 13 publications

Functional evaluation of the lung resection candidate

Functional evaluation of the lung resection candidate

Prediction of Postoperative Lung Function

Effect of exercise on lung-perfusion scanning in patients with bronchogenic carcinoma

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