AB 17. Cardiopulmonary exercise testing (CPET) as preoperative test before lung resection

Lung resection is still the only potentially curative therapy for patients with localised non-small lung cancer (NSCLC). However, the presence of cardiovascular comorbities and known underlying lung disease increase the risk of perioperative death and postoperative complications. Various studies have evaluated the use of different preoperative tests with aim to identify patients with impaired pulmonary function at greater risk for complications. Postoperative complications are associated with prolonged hospital stays and excessive morbidity and mortality especially in this group of patients. According to the ACCP/BTS guidelines, patients without known underlying lung disease with a preoperative FEV1 in excess of 2 L, generally tolerate pneumonectomy whereas those with FEV1 greater that 1.5 L, tolerate lobectomy. Although spirometric values strongly correlate with the severity of obstruction, they do not provide direct information regarding the degree of gas exchange impairment that is often present and the cardiovascular function. Cardiopulmonary exercise testing (CPET) is considered among the preoperative tests suggested before lung resection for patients with known underlying cardiovascular or lung disease. CPET is based on the interactions among the pulmonary function, the cardiovascular function and the oxygen absorption from the peripheral tissues. Patients with maximal oxygen consumption (VO₂ <15 mL/kg/min and both postoperative FEV₁ and DLCO <40% g/min and both postoperative FEV₁ and DLCO <40% predicted are considered to be at high risk for perioperative death and cardiopulmonary complications postoperatively. Studies have shown that oxygen uptake efficiency slope, oxygen pulse and heart rate at peak exercise are correlated with better postoperative outcome.