Exercise capacity and extent of resection as predictors of surgical risk in lung cancer

Lung resection remains the most effective treatment for non-small cell lung cancer (NSCLC), However, there is no consensus about reliable operative ri sk assessment in these patients. The aim of this study was to identify pred ictors of postoperative complications and death after lung resection for NS CLC. In this prospective trial, 125 of 142 (88%) consecutive NSCLC patients from 1990 to August 1997 had complete data sets. All underwent functional asses sment including spirometry and cardiopulmonary exercise tests and lung rese ction via thoracotomy. Complications occurred in 31 of 125 (25%) patients including 2 (1.6%) death s. On logistic regression analysis, only maximal oxygen uptake (V'O-2,max). kg body weight(-1) expressed as a percentage of the predicted value (p<0.00 01) and the estimated extent of lung tissue resection (p=0.02) were indepen dent predictors of postoperative complications. Six of seven patients with a V'O-2,max.kg body weight(-1) of <60% pred, but only eight of 65 with valu es >90% pred, exhibited postoperative complications. Maximal oxygen uptake and the estimated extent of lung tissue resection are independent predictors of postoperative complications. These simple parame ters should be integrated into the preoperative decision analysis for opera bility in patients undergoing lung resection for lung cancer.