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Titolo:
FUNCTIONAL-EVALUATION OF THE LUNG RESECTION CANDIDATE
Autore:
BOLLIGER CT; PERRUCHOUD AP;
Indirizzi:
UNIV BASEL HOSP,UNIV CLIN,DIV PNEUMOL,PETERSGRABEN 4 CH-4031 BASEL SWITZERLAND
Titolo Testata:
The European respiratory journal
fascicolo: 1, volume: 11, anno: 1998,
pagine: 198 - 212
SICI:
0903-1936(1998)11:1<198:FOTLRC>2.0.ZU;2-S
Fonte:
ISI
Lingua:
ENG
Soggetto:
POSTOPERATIVE PULMONARY-FUNCTION; PREOPERATIVE ASSESSMENT; BRONCHOGENIC-CARCINOMA; BRONCHIAL-CARCINOMA; EXERCISE CAPACITY; HIGH-RISK; MYOCARDIAL-INFARCTION; CANCER PATIENTS; CARDIAC RISK; CARDIOPULMONARY FUNCTION;
Keywords:
EXERCISE TESTING; LUNG RESECTION; MORBIDITY; MORTALITY; PREOPERATIVE EVALUATION; POSTOPERATIVE PREDICTED FUNCTION; PULMONARY FUNCTION;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
164
Recensione:
Indirizzi per estratti:
Citazione:
C.T. Bolliger e A.P. Perruchoud, "FUNCTIONAL-EVALUATION OF THE LUNG RESECTION CANDIDATE", The European respiratory journal, 11(1), 1998, pp. 198-212

Abstract

Advances in operative technique and perioperative care have considerably reduced surgical morbidity and mortality after pulmonary resections. Various single and combined parameters of functional operability have been proposed to assess the surgical risk. Pulmonary function testsadequately assess the pulmonary risk, and baseline or stress electrocardiography, echocardiography and nuclear cardiac studies assess the cardiac risk. Patients with normal or only slightly impaired pulmonary function (forced expiratory volume in one second (FEV1) and transfer factor of the lung for carbon monoxide (TL,CO) greater than or equal to80% of predicted) and no cardiovascular risk factors can undergo pulmonary resections up to a pneumonectomy without further investigation. For others, exercise testing, pulmonary split-function studies, or a combination of these two methods are recommended. Exercise testing, most frequently performed as a symptom-limited test with the measurement of maximal oxygen uptake (V'O-2,max), assesses both the pulmonary and cardiovascular reserves. A V'O-2,max of <10 mL.kg(-1).min(-1) is generally considered prohibitive for any resection, a value of >20 mL.kg(-1).min(-1) or >75% of predicted normal, safe for major resections. Split-function studies are radionuclide-based estimations of the predictedpostoperative (ppo) values of various parameters. The currently used ppo-parameters are FEV1-ppo, TL,CO-ppo and, most recently, V'O-2,max-ppo. Suggested cut-off values for safe resection are: for FEV1-ppo and TL,CO-ppo greater than or equal to 40% pred; and for V'O-2,max greaterthan or equal to 35% pred, combined with an absolute value of greaterthan or equal to 10 mL.kg(-1).min(-1). The lowest acceptable ppo-values will still have to be established by additional prospective studies. In the long-term, resections involving not more than one lobe usually lead to an early functional deficit followed by later recovery. The permanent functional loss in pulmonary function is small (less than orequal to 10%) and exercise capacity is only slightly reduced or not at all. Pneumonectomy, on the other hand, leads to an early permanent loss of about 33% in pulmonary function and 20% in exercise capacity. Thus, pulmonary function tests alone overestimate the functional loss after lung resection.

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Documento generato il 02/12/20 alle ore 17:07:02