Evaluation of Functional Operability in Patients with Bronchial Cancer

Overview

In view of the dismal prognosis of unresected bronchial cancer, surgical resection should be encouraged even inpatients with borderline cardiopulmonary function. Accurate estimation of the cardiopulmonary reserve is thereforedesirable to avoid denying potentially curative treatment on the on hand and severe postoperative disability on theother. Various parameters (lung volumes, gas exchange, pulmonary hemodynamics, exercise endurance) are reviewedconcerning their predictive value to evaluate functional operability. No ideal test exists. During exercise bothpulmonary and cardiac risk can be evaluated simultaneously. The high predictive value of maximal oxygen uptaketo assess postoperative morbidity and mortality is established. The postoperative values for the forced expiratoryvolumes, the transfer factor, and maximal oxygen uptake can be predicted by means of quantitative lung scans.A new four-stage algorithm for the functional evaluation is presented. Patients with normal lung function andexercise electrocardiography can undergo lung resection up to a pneumonectomy without further diagnosticprocedures. In others, first the predicted postoperative values of forced expiratory volume and transfer factor shouldbe estimated by taking into account the number of segments to be resected. Patients with values < 30 % predictedare regarded as inoperable, whereas values > 40 % predicted quality for resection without the need for furtherdiagnostics. Patients with values between 30 - 40 % predicted are further differentiated with cardiopulmonaryexercise testing and for those cases where diagnostic uncertainty still remains, predicted postoperative values canbe calculated using quantitative lung scans.

Key words:
bronchial carcinoma, lung resection, preoperative staging, lung function, exercise testing, pulmonaryhaemodynamics.