title: Exercise testing in the evaluation of patients at high risk for complications from lung resection.
abstract: Exercise testing was performed on 37 patients with resectable lung lesions who were deemed inoperable because of any of the following risk factors: (1) FEV1 less than or equal to 40 percent of predicted; (2) radionuclide calculated postlobectomy FEV1 less than or equal to 33 percent of predicted; or (3) arterial PCO2 greater than or equal to 45 mm Hg. The patients who reached a peak level of oxygen consumption during exercise (VO2Peak) of greater than or equal to 15 ml/kg/min were offered surgical treatment. Patients with a VO2Peak of less than 15 ml/kg/min were referred for nonsurgical management and excluded from the study. Eight patients underwent lung resection. Their pulmonary function revealed a severe obstructive lung defect with a group mean predicted FEV1 of 40 +/- 6 percent, an FEV1/FVC ratio of 47 +/- 10, a radionuclide calculated postlobectomy FEV1 of 31 +/- 4 percent, and a mean arterial PCO2 of 44 +/- 6 mm Hg. No relationship was found between each patient's exercise performance and spirometric function. Six of the patients had an uncomplicated postoperative course. Two patients had complications but no patient died as a result of surgery or postoperative complications. All patients were discharged from the hospital within 22 days (mean = 9.8 days). We conclude that exercise testing is a useful complement to conventional cardiopulmonary evaluation used in selecting patients for lung resection.
authors.affiliation: Department of Medical Specialties, University of Texas M.D. Anderson Cancer Center, Houston.
authors.forename: R C
authors.initials: RC
authors.lastname: Morice
authors.forename: E J
authors.initials: EJ
authors.lastname: Peters
authors.forename: M B
authors.initials: MB
authors.lastname: Ryan
authors.forename: J B
authors.initials: JB
authors.lastname: Putnam
authors.forename: M K
authors.initials: MK
authors.lastname: Ali
authors.forename: J A
authors.initials: JA
authors.lastname: Roth
mesh_terms: D000368:Aged; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011877:Radionuclide Imaging; D012129:Respiratory Function Tests; D012307:Risk Factors; D014109:Total Lung Capacity; D014692:Ventilation-Perfusion Ratio; D014797:Vital Capacity