Preoperative Evaluation of Cardiopulmonary Function in Patients with Lung Cancer

The 30-day operative mortality was 1.3% among 7099 patients, who underwent thoracotomy for lung cancer in 1994 in Japan. Since the most frequent cause of death was pulmonary complications, I reviewed studies in the literature reporting preoperative cardiopulmonary function tests used to predict postoperative pulmonary complications. In the 1950s to 1970s, many studies using spirography were done and FEV₁ or MVV, which shows obstructive pulmonary function disorders, were reported to be useful. During the same period, the unilateral pulmonary artery occlusion test was developed and pneumonectomy criteria were established. In the 1970s to 1980s, postoperative pulmonary function was predicted using pulmonary ventilation or perfusion scintigraphy or numbers of segments or subsegments. High correlations between predicted and measured postoperative pulmonary functions were demonstrated. Predicted postoperative FEV₁ was extremely useful for predicting postoperative pulmonary morbidity, but not mortality. In the 1980s, a new method measuring V̇O₂ during exercise testing was applied to preoperative evaluation and V̇O₂max and empirical anaerobic threshold were reported to predict both postoperative mortality and survivable morbidity. These findings suggest that cardiopulmonary rehabilitation should be attempted to prevent post-thoracotomy pulmonary morbidity and mortality.