Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 3 2006 © The Board of Management and Trustees of the British Journal of Anaesthesia [2006]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Assessment of suitability for lung resection
SpR 5, Thoracic Anaesthesia, Guy's and St Thomas' Hospital London
Consultant Anaesthetist, Department of Anaesthesia, Guy's and St Thomas' Hospital London SE1 9RT, UK Tel: 020 7188 0644 Fax: 020 8468 7466 E-mail: adrian.pearce@gstt.nhs.uk (for correspondence)
| The first 150 words of the full text of this article appear below. |
| Key points Co-morbidity is common in patients with lung cancer. A preoperative FEV1 of >1.5 litre for lobectomy and >2.0 litre for pneumonectomy generally indicates suitability. Values less than this should prompt further investigation of respiratory function. A thorough assessment of cardiorespiratory reserve includes calculation of predicted postoperative pulmonary function. CPET should be available in centres providing a thoracic surgical service. A multidisciplinary approach is essential and should include anaesthetist, chest physician, thoracic surgeon and radiologist.
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Approximately 2400 lobectomies and 500 pneumonectomies are undertaken in the UK annually, the majority for malignancy. For this group of patients, in-hospital mortality rates are 2–4% and 6–8%, respectively in the UK, although world mortality rates as high as 11% have been cited for pneumonectomy. For lung cancer surgery, there are three pre-requisites before pulmonary resection is even considered. The tumour type should be non-small cell (the majority are squamous cell or adenocarcinoma), the
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Tests of pulmonary function |
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Lung function tests pre-surgery
Predicted postoperative respiratory function
Ventilation/perfusion scanning
Exercise capability
Cardiopulmonary exercise testing
Arterial blood gases
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Predictive power of preoperative tests |
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Algorithms