Preoperative evaluation of lung cancer: predicting the impact of surgery on physiology and quality of life.
OBJECTIVE
To summarize the best clinical evidence published in the last year and regarding the functional evaluation and the residual quality of life after lung resection in patients with lung cancer.


RESULTS
Recent evidences have shown that predicted postoperative forced expiratory volume in 1 s is not a reliable predictor of complications in patients with obstructive pulmonary disease and that carbon monoxide lung diffusion capacity predicts complications even in patients with normal forced expiratory volume in 1 s. Maximal stair-climbing test appears to discriminate better between complicated and noncomplicated patients compared with traditional split-lung function measures. Patients unable to climb 12 m have 2.5-fold and 13-fold higher complications and mortality rates compared with those able to climb 22 m. Quality of life has been shown to decrease in the first month but to return to preoperative values after 3 months in most of the patients after lung resection.


CONCLUSIONS
Carbon monoxide lung diffusion capacity and stair-climbing test should be performed routinely in all lung-resection candidates. In those with poor exercise tolerance in stair-climbing test or exercise oxygen desaturation, or candidates to pneumonectomy, the measurement of VO2max is recommended. Quality of life should always be assessed through specific instruments and not inferred by traditional functional tests.
Division of Thoracic Surgery, Umberto I Regional Hospital, Ancona, Italy. alexit_2000@yahoo.com
Alessandro
A
Brunelli
Michele
M
Salati
D001784:Blood Gas Analysis; D005080:Exercise Test; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology* / Q000523:psychology / Q000601:surgery*; D011013:Pneumonectomy; D011300:Preoperative Care / Q000379:methods*; D011653:Pulmonary Diffusing Capacity / Q000502:physiology; D011788:Quality of Life; D012129:Respiratory Function Tests