Evaluation der funktionellen Operabilität vor thoraxchirurgischen Eingriffen

Die meisten thoraxchirurgischen Operationen sind geplante Eingriffe. Die Patientenselektion im Vorfeld spielt daher eine entscheidende Rolle, dem „richtigen Patienten“ die „richtige Operation“ zukommen zu lassen. Eine standardisierte präoperative Lungenfunktionsanalyse soll erreichen, dass keinem funktionell operablen Patienten die Operation verwehrt wird, andererseits kein funktionell inoperabler Patient einer Lungenresektion zugeführt wird.

Abstract

Cardiac and pulmonary physiologic assessment is necessary for risk stratification before any lung resection. It may uncover hidden health issues, which can be addressed first to make patients fit for surgery. It allows for the surgeon to estimate the patient’s risk for major complications and at the same time for the patient to understand the procedural risks and give informed consent or even reject surgery. Recommended work-up for both to cardiac risk evaluation and preoperative pulmonary function test algorithms are based on guidelines formulated by the ERS/ESTS and ACCP [1] [3] [4].

Basic pulmonary function tests consist of spirometry, blood gas analysis and measurement of diffusion capacity (DLCO); followed by cardiopulmonary exercise testing (CPET) which estimates or measures the patient’s oxygen consumption, and split function tests such as perfusion scintigraphy. Clinical assessment of both the patient’s overall status and pulmonary function allows for an adequate assessment of overall operative risk. Pulmonary function tests are affected by multiple variables and as such prone to error. It is advisable to always question the validity of every work-up and to repeat any test if necessary.

Kernaussagen

• Die kardiale und pulmonale Funktionsdiagnostik ist ein zwingend notwendiges Instrument zur präoperativen Risikostratifizierung lungenchirurgischer Patienten.

• Durch die sorgfältige präoperative Funktionsdiagnostik lassen sich gesundheitliche Schwachstellen des Patienten erkennen und behandeln. Dies erlaubt dem Patienten, das Risiko eines Eingriffs zu verstehen und mitzutragen oder einen Eingriff abzulehnen.

• Die präoperative Lungenfunktionsdiagnostik orientiert sich an den europäischen und amerikanischen Leitlinien der entsprechenden Fachgesellschaften (ERS/ESTS bzw. ACCP) [1] [4].

• Grundlegende Bausteine der präoperativen Lungenfunktionsdiagnostik sind Spirometrie bzw. Bodyplethysmografie, Blutgasanalyse und Diffusionsmessung. Im nächsten Schritt kommen Belastungsuntersuchungen zum Tragen. Die gemeinsame Betrachtung des klinischen Zustands des Patienten und seinen Funktionswerten erlaubt eine differenzierte Risikoeinschätzung vor einer Lungenresektion.

• Lungenfunktionsuntersuchungen sind multifaktoriell beeinflussbar und daher fehleranfällig. Man sollte stets die Validität der Untersuchungen kritisch hinterfragen. Im Zweifelsfall ist eine Untersuchung zu wiederholen

Schlüsselwörter

Lungenresektion - Lungenfunktionsdiagnostik - Thoraxchirurgie - Algorithmus

Keywords

lung resection - cardiac evaluation - pulmonary function tests - thoracic surgery - algorithm

Publication History

Article published online:
15 June 2022

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