Prediction of Postoperative Lung Function

Lung cancer is the leading cause of cancer death in many counties. Despite significant improvement in chemotherapy and radiotherapy, surgery is still the cornerstone of nonsmall cell lung cancer treatment. The lung cancer is categorized into non-small cell lung cancer or small cell lung cancer according to the histology. The patients with stage IA-IIB non-small cell lung cancer and stage I small cell lung cancer are good candidates for lung resection which can offer the best chance for cure. In a series of 407 individuals with resectable cancer, the 346 who went to thoracotomy had a median survival of 30.9 months compared with 15.6 months in the 57 who did not go to surgery (Loewen, et al. 2007). A part of individuals with stage IIIA non-small cell stage may also be the surgical candidates if they are adequately treated with chemotherapy and/or radiotherapy before and/or after surgery. The long term goals of lung cancer surgery include cancer control improving survival and quality of life of the patients. Smoking is the important risk factor not only for lung cancer but also for other comorbid diseases such as chronic obstructive pulmonary disease (COPD) and coronary heart disease. The patients with lung cancer and COPD have reduced ability to tolerate further losses in lung function. Because of relatively high incidence of postoperative complications, the hospital mortality, as well as disappointing long-term survival after surgical resection of lung cancer, the appropriate selection of patients for pulmonary resection is a continuing challenge. It was reported that only about 30% of individuals with lung cancer were determined to be candidates for lung resection because of the advanced stage (Damhuis & Schutte 1996). In addition, a report showed that 37% of individuals who present with anatomically resectable disease deemed not to be surgical candidates based on poor lung function alone (Baser, et al. 2006). If a patient is deemed a candidate for surgery, it must be realized that pulmonary function will be affected by the resection. The decline in lung function varies with the extent of the resection. Accordingly, it is important to be informed about the risk factors and how they affect postoperative morbidity, mortality, and long-term survival. Pulmonary function measures such as the forced expiratory volume in one second (FEV1) and the diffusing capacity for carbon monoxide (DLco) are useful predictors of postoperative outcome (Bousamra, et al. 1996; Ferguson, et al. 1988; Markos, et al. 1989). Postoperative value of FEV1 is certainly the most widely used parameter for preoperative risk stratification. It has been shown to be an independent predictor of complications including mortality (Kearney, et al. 1994; Mitsudomi, et al. 1996; Ribas, et al. 1998). The