Preoperative Pulmonary Functional Evaluation for Thoracic and Cardiothoracic Surgery

Abstract

It is in the arena of thoracic surgery that preoperative pulmonary function testing has its most established role. Patients evaluated for lung resection, especially for lung cancer, frequently demonstrate concomitant airflow obstructive disease. An FEV1 >2 L (>60% of predicted) usually signifies that the patient can tolerate even a pneumonectomy, if needed. If patients with an anatomically resectable lung cancer have an FEV1 <2 L (<60% of predicted), they should not be summarily rejected for potentially lifesaving surgery. However, further physiologic testing is indicated. This additional testing should include a quantitative lung scan prediction of post-operative pulmonary function (PPO). If the ppoFEV1 is >40% of predicted normal, then surgery for cure should be attempted as regional pulmonary function is acceptable. When the ppoFEV1 is 30–40% of predicted, additional testing with exercise oxygen uptake (VO2) measurements are indicated. If the exercise VO2 is >15 mL/kg/min, surgery may be offered as global oxygen transport is acceptable. If, however, the patient with lung cancer “fails” all test criteria, earnest discussion concerning early mortality or prolonged disability from cardiorespiratory insufficiency versus a later cancer death is indicated. The patient, thereby, should have significant input in the final decision.