CHEST Guidelines-Physiologic-Evaluation-of-the-Patient-With-Lung-Ca

Physiologic-Evaluation-of-the-Patient-With-Lung-Ca

Pdf Summary

The document outlines the American College of Chest Physicians (ACCP) guidelines for the physiologic evaluation of patients being considered for lung cancer resection surgery. It emphasizes an evidence-based approach to determining the suitability and risk for surgery through comprehensive preoperative assessment.<br /><br />Key steps in the evaluation include baseline cardiovascular evaluation and spirometry to measure Forced Expiratory Volume in one second (FEV1) and Diffusing Capacity for Carbon Monoxide (DLCO). Predicted postoperative (PPO) lung functions are critical. Patients with PPO values over 60% are considered low risk, while those between 30% and 60% undergo simpler exercise tests like stair climbing. Further cardiopulmonary exercise testing is reserved for patients with PPO values below 30% or unsatisfactory exercise test performances. Peak oxygen consumption is also a pivotal measure, with values under 10 mL/kg/min indicating high surgical risk.<br /><br />Other considerations include multi-disciplinary team evaluations, especially for elderly patients or those with elevated cardiovascular risk. Guidelines emphasize that even high-risk patients might undergo surgery if exercise capacity tests are favorable, indicating potential benefits of tailoring surgical approaches.<br /><br />Methods to mitigate risk, such as lung volume reduction surgery (LVRS), smoking cessation programs, and pre/postoperative pulmonary rehabilitation, are recommended for suitable candidates to improve outcomes and reduce perioperative risks and long-term disability.<br /><br />The document stresses the importance of specialized surgical centers in achieving better long-term outcomes and highlights the necessity for patient counseling about risks versus benefits, especially when surgery is high risk due to overall patient health or functional capacity. These guidelines are crucial for making informed decisions about lung cancer surgical interventions.

Keywords

ACCP guidelines

lung cancer resection

physiologic evaluation

preoperative assessment

spirometry

FEV1

DLCO

cardiopulmonary exercise testing

lung volume reduction surgery

patient counseling