RESECTION OF LUNG-CANCER IS JUSTIFIED IN HIGH-RISK PATIENTS SELECTED BY EXERCISE OXYGEN-CONSUMPTION

The medical criteria for inoperability have been difficult to define i n patients with lung cancer. Sixty-six patients with non-small cell lu ng cancer and radiographically resectable lesions were evaluated prosp ectively in a clinical trial. The patients were considered by cardiac or pulmonary criteria to be high risk for pulmonary resection. If exer cise testing revealed a peak oxygen uptake of 15 mL.kg(-1).min(-1) or greater, the patient was offered surgical treatment. Of the 20 procedu res performed, nine were lobectomies, two were bilobectomies, and nine were wedge or segmental resections. All patients were extubated withi n 24 hours and discharged within 22 days after operation (median time to discharge, 8 days). There were no deaths, and complications occurre d in 8 (40%) of the 20 patients. Five patients whose peak oxygen uptak e was lower than 15 mL.kg(-1).min(-1) also underwent surgical interven tion; there was one death. Thirty-four patients whose peak oxygen upta ke was less than 15 mL.kg(-1).min(-1) and 7 who declined operation und erwent radiation therapy alone (35 patients) or radiation therapy and chemotherapy (6 patients). There were no treatment-related deaths, and the morbidity rate was 12% (5/41). The median duration of survival wa s 48 +/- 4.3 months for the patients treated surgically and 17 +/- 2.7 months for those treated medically (p = 0.0014). We conclude that a s ubgroup of patients who would be considered to have inoperable disease by traditional medical criteria can be selected for operation on the basis of oxygen consumption exercise testing. There is a striking surv ival benefit to an aggressive surgical approach in these patients.