Preoperative assessment for lung cancer surgery.
OBJECTIVE
Pulmonary resection remains the only curative treatment option for lung cancer surgery. This review summarizes recent advances in the preoperative functional evaluation of the patient with lung cancer.


RESULTS
The workup of patients with bronchogenic carcinoma covers three areas: tumor type, tumor extent, and patient cardiopulmonary reserves. Significant advances have been made in the latter two areas. Traditionally lobectomy was regarded as the minimum resection for lung cancer; new studies are challenging this view and suggesting that segmentectomy is acceptable for stage Ia cancers < or =20 mm. An important change relating to cardiopulmonary reserves of the patient is the shift in emphasis toward early exercise testing and, in particular, the use of stair climbing as a surrogate marker of maximal oxygen consumption. New studies confirm the benefit of combined lung volume reduction surgery and lung cancer surgery in certain patients who might otherwise be excluded from surgery because of poor lung function.


CONCLUSIONS
Advances in the preoperative workup of lung cancer patients and in surgical techniques are permitting resections in previously inoperable patients. A new, simplified algorithm for the preoperative workup of lung cancer patients assessing the value of stair climbing as a surrogate marker of maximal oxygen consumption is proposed.
Bolliger
Chris T
CT
Respiratory Research Unit, Medical School, Faculty of Health Sciences Tygerberg Academic Hospital and University of Stellenbosch, Cape Town, South Africa. ctb@sun.ac.za
Koegelenberg
Coenraad F N
CF
Kendal
Rosamund
R
D000367:Age Factors; D000465:Algorithms; D002283:Carcinoma, Bronchogenic / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D011013:Pneumonectomy; D012129:Respiratory Function Tests