Lung cancer resection - The prediction of postsurgical outcomes should include long-term functional

Study objectives: To assess (1) the possibility of predicting long-term pos toperative lung function, and (2) the usefulness of maximal oxygen consumpt ion (Vo(2)max) as a criterion for operability and as a predictor of long-te rm disability. Design: Prospective study. Setting: Outpatients and inpatients of a. university hospital. Participants: Sixty-two consecutive patients (mean +/- SD age, 62 +/- 8 yea rs; 51 male and 11 female patients) were preoperatively evaluated for lung cancer resection (pneumonectomy or bilobectomy [n = 14] and lobectomy [n = 481). Measurements: Clinical examination and recorded respirator) symptoms and sp irometry results before surgery and 6 months after surgery. If predicted po stoperative FEV1 (ppoFEV(1)) was < 40%, patients underwent exercise testing ; if Vo(2)max was between 10 ml/kg/min and 20 ml/kg/min, patients underwent a split-function study. Results: All the patients with ppoFEV(1) greater than or equal to 40% - eve n those patients (26%) with FEV1 < 80% underwent thoracotomy without furthe r tests. Seven patients with ppoFEV1 < 40% underwent exercise testing, and three of them underwent a split-function study. Nine patients (15%; includi ng six patients with COPD and one patient with asthma) had immediate postop erative complications (pneumonia [n = 5] and respiratory failure [n = 4]); seven of these patients had ppoFEV(1) greater than or equal to 40%, ppoFEV, significantly underestimated the actual postoperative FEV1 (poFEV(1); p < 0.001) 6 months after pneumonectomy or bilobectomy but was reliable for act ual poFEV(1) after lobectomy, Two patients with predicted postoperative Vo( 2)max > 10 ml/kg/min became oxygen dependent and had marked limitation of d aily living. Conclusions: ppoFEV(1) greater than or equal to 40% reliably identifies pat ients not requiring further tests and not at long-term risk of respiratory disability. Vo(2)max, effective for defining the immediate surgical risk, i s not useful in predicting long-term disability.