title: Risk Stratification in Lung Resection.
abstract: OBJECTIVE
  Surgery is considered the best treatment option for patients with early stage lung cancer. Nevertheless, lung resection may cause a variable functional impairment that could influence the whole cardio-respiratory system with potential life-threatening complications. The aim of the present study is to review the most relevant evidences about the evaluation of surgical risk before lung resection, in order to define a practical approach for the preoperative functional assessment in lung cancer patients.
  
  
  RESULTS
  The first step in the preoperative functional evaluation of a lung resection candidate is a cardiac risk assessment. The predicted postoperative values of forced expiratory volume in one second and carbon monoxide lung diffusion capacity should be estimated next. If both values are greater than 60 % of the predicted values, the patients are regarded to be at low surgical risk. If either or both of them result in values lower than 60 %, then a cardiopulmonary exercise test is recommended. Patients with VO2max >20 mL/kg/min are regarded to be at low risk, while those with VO2max <10 mL/kg/min at high risk. Values of VO2max between 10 and 20 mL/kg/min require further risk stratification by the VE/VCO2 slope. A VE/VCO2 <35 indicates an intermediate-low risk, while values above 35 an intermediate-high risk.
  
  
  CONCLUSIONS
  The recent scientific evidence confirms that the cardiologic evaluation, the pulmonary function test with DLCO measurement, and the cardiopulmonary exercise test are the cornerstones of the preoperative functional evaluation before lung resection. We present a simplified functional algorithm for the surgical risk stratification in lung resection candidates.
authors.affiliation: Division of Thoracic Surgery, Ospedali Riuniti Ancona, Via Conca 1, 60020 Ancona, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Salati
authors.affiliation: Department Thoracic Surgery, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF UK.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Brunelli
keywords: Cardiac risk; Co-morbidities; Exercise test; Lung cancer surgery; Lung resection; Morbidity; Mortality; Operative Risk; Preoperative evaluation; Pulmonary function