Lack of Utility of Thoracoscore in Evaluating Fitness for Surgery in Lung Cancer.

BACKGROUND The thoracic surgery scoring system (Thoracoscore) is a multivariate scoring system with nine parameters used for predicting inpatient mortality after thoracic surgery. In clinical practice, the value of the thoracoscore in evaluating the fitness of individual patients for surgery is not clear. OBJECTIVE The study objective was to evaluate the performance of thoracoscore in evaluating fitness for surgery for lung cancer and compare it with cardiopulmonary exercise test (CPEX). METHODS We retrospectively analysed data over a 2-year period from the CPEX database of patients referred for preoperative assessment prior to surgery for lung cancer. RESULTS Twenty-two patients who had borderline lung function impairment had CPEX to assess fitness for surgery. Fifteen (68%) were deemed fit and went on to have thoracic surgery while 7 (32%) were considered high risk and were turned down. The predicted death rate based on thoracoscore for patients who had surgery was 3.5 ± 2.8 as compared to 3.4 ± 2.0 for patients who did not have surgery (p > 0.05). The mean peak VO2 (peak oxygen uptake during CPEX) among those who had surgery was significantly higher than those who did not have surgery (14.2 mL/kg/min versus 10.1 mL/kg/min). There was no correlation of thoracoscore with lung function parameters, duration of hospital stay and peak VO2. CONCLUSIONS Our study showed that CPEX remains a standard and useful tool for functional assessment prior to lung cancer resection. There is no correlation between thoracoscore and either CPEX or pulmonary function parameters. Thoracoscore should not be used to assess fitness for surgery.