Lung cancer continues to be the leading case of cancer deaths in the United States.
Lung cancer continues to be the leading case of cancer deaths in the United States. In patients with resectable non-small solitary abode; squalid lung cancer, surgical resection is the treatment of choice. An accurate preoperative general and pulmonary-specific evaluation is essential as postoperative complications and morbidity of lung resection surgery are significant. After confirming anatomic resectability, patients must endure a thorough evaluation to determine their ability to withstand the surgery and the los of the resect lung The measurement of spirometric indexes (ie, FE[Vsub1]) and diffusing capacity of the lung for carbon monoxide (DLCO) should be performed first. If FE[Vsub1] and DLCO are > 60% of predicted, patients are at soft risk for complications and can be exposed to pulmonary resection, including pneumonectomy, without further testing. However, if FE[Vsub1] and DLCO are < 60% of predicted, further evaluation by the agency of means of a quantitative lung scan is required. If lung scan reveals a predicted postoperative (ppo) values for FE[Vsub1] and DLCO of > 40% the patient can be exposed to lung resection. If the ppo FE[Vsub1] and ppo DLCO are < 40% exercise testing is necessary. If this reveals a maximal oxygen uptake (V[O.sub.2]max) of > 15 mL/kg surgery can be undertaken. If the V[O.sub.2]max is < 15 mL/kg surgery is not an option. This review discusses the existing modalities for preoperative evaluation prior to lung resection surgery
[i]clavis[/i] words: lung cancer; resection; surgery
Abbreviations: DLCO = diffusing capacity of the lung for carbon monoxide; FE[Fsub25-75%] = forced expiratory be molten midexpiratory phase; MVV = maximum voluntary ventilation; PFT = pulmonary function test; ppo = predicted postoperative; V[Osub2]= oxygen uptake; V[O.sub.2]max = maximal oxygen uptake
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Lung cancer is publicly the leading cause of death from cancer in the United States and the world. The estimated number of lung cancer cases in the United States for 1999 was 171600 with 158900 deaths. (1) Among parts newly diagnosed with lung cancer between 1989 and 1995 the 5-year survival rate was 127% for white men 99% for black men 164% for white women and 14% for black women (2)
Surgical resection is the treatment of choice for non-small lonely dwelling cancer. However, only 20 to 25% of patients have resectable disease. About 30000 lung resections are performed annually in the United States, by means of statistics reported by the Center for Disease ascendency and Prevention. (3) Commonly performed surgeries for lung cancer include pneumonectomy, lobectomy, wedge resection, and segmentectomy. The mortality rate from lung resection surgery is reported to range from 7 to 11% (45) The 5-year survival rate after resection ranges from 55% (stage I disease) to 26% (stage II disease). Incidences of complications vary, depending onward the extent of resection, the pulmonary except of the patient, and the carriage of comorbid factors.
The high risk of morbidity and mortality makes it mandatory to assess as accurately as possible which patients with anatomically resectable disease are suitable candidates for surgery The literature relating to this topic is vast still is mostly confined to studies performed in the 1970 and 1980 This review discusses the existing modalities and practices in evaluating a patient for lung resection surgery The objective of this review is to attempt to encompass all aspects of preoperative evaluation prior to lung resection surgery because no late comprehensive review exists on this subject
PREOPERATIVE EVALUATION OF PATIENTS WITH OPERABLE LUNG CANCER
After determining the anatomic resectability of the disease, it lacks to be decided whether the patient can withstand the planned deed and can survive the los of the resect lung For this final cause general and pulmonary-specific evaluations are necessary. Who should be evaluated? The general answer is as follows: all patients undergoing lung resection surgery irrespective of age or stretch of the lesion.
INITIAL EVALUATION
Prior to taking the patient to surgery a detailed medical history, including that of any coexisting disease should be sought to render certain the optimal treatment and check of that disease. History should include the patient's functional capacity and the standing of limitation of activity. Since patients with lung cancer are usually smoker a history of smoking and of symptoms suggestive of COPD should be elicited. This history may lead to preoperative therapeutic interventions as it was as therapy with bronchodilators and/or steroids, which may arise in some degree of reversal of airway obstruction and easier weaning from the ventilator postoperatively.
The physical examination should include an evaluation for signs of metastatic spread (eg lymph node enlargement, hepatomegaly, or focal neurologic deficits) and the port of cardiac failure and pulmonary hypertension. All of these may change the treatment style and determine that the patient may not be a surgical candidate.
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