Preoperative assessment of surgical risk in patients with lung cancer
23 February 2017 (online)
Pulmonary resection surgery remains the treatment of choice for early-stage bronchogenic carcinoma (BC). However the relationship with exposure to tobacco and other comorbidities contributes to poor lung function in these cases. Minimizing the negative prognosis of surgery is critical, so we must make a functional assessment and identify patients at high risk for perioperative complications and functional limitations after surgery.
Material and methods:
Prospective observational study of a cohort of 22 patients diagnosed with lung cancer who consulted the thoracic surgery clinic for lung resection assessment over a period of 6 months. Anthropometric data, clinical history, pulmonary function tests and the results of incremental cycle ergometry with 15 watts protocol were analyzed. Surgical risk assessment followed the algorithm for thoracotomy and greater anatomic resection of the ACCP (American College of Chest Physicians).
Twenty-five patients were assessed (91.7% males) ages 69 ± 6.9 years, FEV1 of 2.0 ± 7.3L and mean maximum oxygen consumption (VO2) 1050 ± 252 mL/min. Predicted postoperative values were calculated for the proposed intervention by thoracic surgery.
A total 58.3% of the patients studied were considered to be high risk for the proposed surgery and ultimately only 21.4% underwent the surgery, while the remaining 78.6% did not and were referred to Oncology, Radiation Oncology or the Palliative Care Unit. Of the 25 patients analyzed, ultimately 10 received the surgery.
Of those who underwent surgery, 64% presented low surgical risk, 25% moderate risk and 11% high risk for the calculated surgery.
Of those who underwent surgery, 9.4% suffered complications in the immediate postoperative period, the main complication being persistent air leak.
The role of ergometric testing and calculating predicted postoperative lung function are vital to calculate the preoperative surgical risk, as most of those classified as high risk ultimately do not undergo surgery.
The decision whether or not to operate patients with lung cancer requires a multidisciplinary approach, given the comorbidities these patients present.