PREDICTIVE VALUE OF EXERCISE TESTING IN T HE EVALUATION OF HIGH-RISK PATIENTS PRIOR TO LUNG RESECTION

Surgical resection for lung cancer provides the only real chance for c ure. However, there is a high risk of postoperative complications incl uding death for patients with pulmonary dysfunction. Therefore preoper ative identification of patients at risk is necessary. Apart from hist ory and physical examination three tests are currently used: 1. restin g lung function (RFL), 2. invasive measurement of pulmonary vascular r esistance (PVR) and 3. exercise testing with measurement of oxygen con sumption Main studies in the literature report the probability of abno rmal tests for prediction of pulmonary complications (positive predict ive value) and the probability of normal tests for prediction of uneve ntful outcome (negative predictive value) as follows: RLF PVR VO2 posi tive predictive 0.27(8) 0.36(2)* 0.70(4)* negative predictive 0.82(8) 0.92(2)* 0.96(4)* * number of studies considered In conclusion, the ''ideal'' test predictive for morbidity and mortality after lung resec tion has not been found. The positive predictive values of RLF and PVR are disappointing, while the negative predictive values are acceptabl e. Measurement of VO2 is simple, noninvasive and might predict surviva ble morbidity, as suggested in the literature. Obviously, additional s tudies are necessary.