Last updated March 15, 2022

Physiologic Evaluation Of The Patient With Lung Cancer Being Considered For Resectional Surgery: Diagnosis And Management Of Lung Cancer

Recommendations

General Issues Regarding Risk

In patients with lung cancer who are potential candidates for curative surgical resection, it is recommended that they be assessed by a multidisciplinary team, which includes a thoracic surgeon specializing in lung cancer, medical oncologist, radiation oncologist and pulmonologist. (1, C)
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In elderly patients with lung cancer who are potential candidates for curative surgical resection it is recommended that they be fully evaluated regardless of age. (1, C)
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In patients with lung cancer being considered for surgery who have increased perioperative cardiovascular risk , a preoperative cardiologic evaluation is recommended, with further management according to existing cardiologic guidelines for non cardiac surgery. (1, C)
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Risk of Perioperative Morbidity and Mortality

In patients with lung cancer being considered for surgery, it is recommended that both FEV1 and DLCO be measured in all patients and that both PPO FEV1 and PPO DLCO are calculated. (1, B)
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In patients with lung cancer being considered for surgery, if both PPO FE 1 and PPO DLCO are >60% predicted, no further tests are recommended. (1, C)
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In patients with lung cancer being considered for surgery, if either the PPO FEV1 or PPO DLCO are <60% predicted and both are above 30% predicted, it is recommended that a low technology exercise test (stair climb or SWT) is performed. (1, C)
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In patients with lung cancer being considered for surgery, with either a PPO FEV1 <30% predicted or a PPO DLCO <30% predicted performance of a formal CPET with measurement of Vomax is recommended. (1, B)
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In patients with lung cancer being considered for surgery who walk <25 shuttles (or <400m) on the SWT or climb <22m at symptom limited stair climbing test, performance of a formal CPET with measurement of Vo2 max is recommended. (1, C)
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In patients with lung cancer being considered for surgery and a Vo2 max <10mL/kg/min or >35% predicted it is recommended that they are counseled about minimally invasive surgery, sublobar resections or nonoperative treatment options for their lung cancer. (1, C)
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Risk of Long-term Pulmonary Disability With Neoadjuvant Therapy

In patients with lung cancer being considered for surgery who undergo neoadjuvant therapy, it is suggested that repeat pulmonary function testing with diffusion capacity be performed after completion of neoadjuvant therapy. (2, C)
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Methods to Reduce Perioperative Risks and Long-term Pulmonary Disability

In patients with lung cancer in an area of upper lobe emphysema who are candidates for LVRS, combined LVRS and lung cancer resection is suggested. (2, C)
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In all patients with lung cancer being considered for surgery who are actively smoking, tobacco dependence treatment is recommended. (1, C)
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In patients with lung cancer being considered for surgery and deemed at high risk (as defined by the proposed functional algorithm, ie, PPO FEV1 or PPO DLCO <60% and Vo2 max <10 mL/kg/min or <35%), preoperative or postoperative pulmonary rehabilitation is recommended. (1, C)
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CPET = cardiopulmonary exercise test; PPO = predicted postoperative; SWT = shuttle walk test

Recommendation Grading

Overview

Title

Physiologic Evaluation Of The Patient With Lung Cancer Being Considered For Resectional Surgery: Diagnosis And Management Of Lung Cancer

Authoring Organization

Publication Month/Year

May 1, 2013

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This section of the guidelines is intended to provide an evidence-based approach to the preoperative physiologic assessment of a patient being considered for surgical resection of lung cancer.

Target Patient Population

Patients with lung cancer

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Operating and recovery room, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D013903 - Thoracic Surgery, D008175 - Lung Neoplasms, D013510 - Pulmonary Surgical Procedures

Keywords

lung cancer, surgery, thoracic surgery