Risk assessment of lung resection for lung cancer according to pulmonary function: republication of systematic review and proposals by guideline committee of the Japanese Association for Chest Surgery 2014

Background: This manuscript provides preoperative physiologic assessments for patients considered for surgical resection of lung cancer. Methods: Medical studies of risk assessment of surgical resection for lung cancer according to pulmonary function were collected and a review article was written to present guidelines. Results: Preoperative physiologic assessment should begin with a cardiovascular evaluation, and spirometry to measure FEV 1 and the diffusing capacity of carbon monoxide (DLCo). Predicted postoperative (ppo) lung functions should also be calculated. If both %ppo-FEV 1 and %ppo-DLCo values are ≥60 %, the patient is considered to be at low risk for anatomic lung resection. If either of those are <60 % of the predicted value, an exercise test should be performed for screening. If performance on the exercise test is acceptable, the patient is regarded to be at low risk for anatomic resection. These findings can be summarized as an algorithm. Conclusions: Careful preoperative physiologic assessment is useful for identifying patients at increased risk for standard lung cancer resection and enabling informed decisions by the patient about an appropriate therapeutic approach for their lung cancer. © 2014, The Japanese Association for Thoracic Surgery.