Summary:
In view of the dismal prognosis of unresected bronchial cancer, surgical resection should be encouraged even in
patients with borderline cardiopulmonary function. Accurate estimation of the cardiopulmonary reserve is therefore
desirable to avoid denying potentially curative treatment on the on hand and severe postoperative disability on the
other. Various parameters (lung volumes, gas exchange, pulmonary hemodynamics, exercise endurance) are reviewed
concerning their predictive value to evaluate functional operability. No ideal test exists. During exercise both
pulmonary and cardiac risk can be evaluated simultaneously. The high predictive value of maximal oxygen uptake
to assess postoperative morbidity and mortality is established. The postoperative values for the forced expiratory
volumes, 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 and
exercise electrocardiography can undergo lung resection up to a pneumonectomy without further diagnostic
procedures. In others, first the predicted postoperative values of forced expiratory volume and transfer factor should
be estimated by taking into account the number of segments to be resected. Patients with values < 30 % predicted
are regarded as inoperable, whereas values > 40 % predicted quality for resection without the need for further
diagnostics. Patients with values between 30 - 40 % predicted are further differentiated with cardiopulmonary
exercise testing and for those cases where diagnostic uncertainty still remains, predicted postoperative values can
be calculated using quantitative lung scans.
Key words:
bronchial carcinoma, lung resection, preoperative staging, lung function, exercise testing, pulmonary
haemodynamics.
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