Preoperative assessment of lung cancer patients before lung resection

The aim of the functional evaluation of lung cancer patients before lung resection is to evaluate the risk of peri-operative cardio-respiratory complications. The successive steps of the functional assessment are determined according to the predictive value, the invasiveness, and the sophistication of the tests. The cardiovascular risk is evaluated using clinical predictors and ECG findings. If both are negative, the first step of the respiratory function assessment will be FEV1 measurement. Simultaneous measurement of CO diffusing lung capacity (D-LCO), which has a high predictive value of complications, is highly recommended by some authors. The second and the third steps will be either exercise testing or split function studies based on quantitative perfusion scan results,the position of the test in the algorithm depending on the authors. Formal exercise testing has been found to be the best predictor of postoperative complications in several studies. However, it does not evaluate the functional contribution of the parenchyma to be resected, which required a perfusion scan. On the other hand, patients with low values of predicted post-operative FEV1 or D-LCO should undergo exercise tests. Eventually, clinical, surgical and anesthetic factors should also be taken into account in addition to the functional evaluation to assess the perioperative risk of the patient.