Perioperative Pulmonary Functional Assessment

Pulmonary resection is the first therapeutic option of various lung pathologies, among which localized non-microcytic bronchogenic carcinoma is the most prevalent. Due to the fact that many patients who develop non-microcytic bronchogenic carcinoma present significant comorbidity, lung resection is associated with an increased risk (between 2 and 5%) of perioperative death (Little et al., 2005). Therefore, it is important to assess the patient's operability, which is defined as the ability to survive the lung resection without leaving any disabling sequelae. As most of these patients are or have been smokers, many of them have varying degree of obstructive lung disease. It is known that the pulmonary obstruction increases the risk of lung resection (Miller et al., 1981), which is why the decision to perform resection depends largely on the functional integrity of the lung not affected by tumor. As the excision supposes a loss of lung function, many years of research have led to a reasonably solid scientific evidence that the postoperative risk depends on post-surgery lung function, which can be estimated preoperatively by knowing the amount of tissue to be resected basing on anatomical size or quantifying it by perfusion scintigraphy (Wernly et al., 1980). On the other hand, it is also known that the functional capacity measured by exercise tests is associated with postoperative mortality (Puente & Ruiz., 2003). This has led to the development of integrated strategies in which basal functional tests are followed by postoperative function estimate and, in borderline patients, by stress testing (Marshall & Olsen 1993).