Brunelli et al made recommendations for the evaluation of a patient undergoing resection of a lung cancer. This can help to determine the patient's risk after surgery. The authors are from the American College of Chest Surgeons.
Patient selection: patient undergoing resection of a lung cancer
Parameters:
(1) predicted post-operative FEV1 in percent
(2) predicted post-operative DLco in percent
Predicted FEV1
Predicted DLco
Action
>= 60%
>= 60%
no further testing
>= 30% and < 60%
NA
simple exercise test such as stair climb or shuttle walk test
NA
>= 30% and < 60%
simple exercise test such as stair climb or shuttle walk test
< 30%
NA
cardiopulmonary exercise test with measurement of maximal oxygen consumption
NA
< 30%
cardiopulmonary exercise test with measurement of maximal oxygen consumption
predicted postoperative FEV1 as percent of predicted =
= (preoperative FEV1 as percent of predicted) * (1 - (fraction of resected functional lung))
where:
• Fraction of resected lung can be determined by postbronchodilator perfusion scan or number of functional and unobstructed segments resected.
If the simple exercise is abnormal (symptom limited at < 400 meters on shuttle walk test or < 22 meters climbed on stair climb) then a cardiopulmonary exercise test with maximal oxygen consumption should be performed. Higher levels of performance are considered low risk.
VO2 in mL per kg per min
VO2 in percent
Risk Group
> 20 or
or > 75%
low
10-20 or
or 35-75%
moderate
< 10 or
or < 35%
high
If maximal oxygen saturation is < 10 mL per kg per min or < 35% of predicted should have minimally invasive surgery, sublobar resections or nonoperative management.
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