Preoperative evaluation for lung cancer resection

Our plain-English summary of Preoperative evaluation for lung cancer resection, by D. Spyratos, P. Zarogoulidis, K. Porpodis, et al (Journal of Thoracic Disease, 2014).

The study

• Authors: D. Spyratos, P. Zarogoulidis, K. Porpodis, N. Angelis, A. Papaiwannou, I. Kioumis, G. Pitsiou, A. Pataka, K. Tsakiridis, A. Mpakas, S. Arikas, N. Katsikogiannis, I. Kougioumtzi, T. Tsiouda, N. Machairiotis, S. Siminelakis, M. Argyriou, M. Kotsakou, G. Kessis, A. Kolettas, T. Beleveslis, K. Zarogoulidis
• Journal: Journal of Thoracic Disease
• Published: 2014;6 Suppl 1(Suppl 1):S162-6
• Type of article: Review
• Cited by: 41 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

During the last decades lung cancer is the leading cause of death worldwide for both sexes. Even though cigarette smoking has been proved to be the main causative factor, many other agents (e.g., occupational exposure to asbestos or heavy metals, indoor exposure to radon gas radiation, particulate air pollution) have been associated with its development. Recently screening programs proved to reduce mortality among heavy-smokers although establishment of such strategies in everyday clinical practice is much more difficult and unknown if it is cost effective compared to other neoplasms (e.g., breast or prostate cancer). Adding severe comorbidities (coronary heart disease, COPD) to the above reasons as cigarette smoking is a common causative factor, we could explain the low surgical resection rates (approximately 20-30%) for lung cancer patients. Three clinical guidelines reports of different associations have been published (American College of Chest Physisians, British Thoracic Society and European Respiratory Society/European Society of Thoracic Surgery) providing detailed algorithms for preoperative assessment. In the current mini review, we will comment on the preoperative evaluation of lung cancer patients.

In plain English

This article was a short review, which the authors called a mini review, about how patients with lung cancer are assessed before surgery to remove part or all of a lung. It did not report new research on any group of patients. Asbestos received only a brief background mention. The abstract and the introduction listed occupational exposure to asbestos, with the introduction citing another study, as one of several agents besides cigarette smoking that have been associated with lung cancer. The review did not discuss asbestos further. The authors compared three sets of clinical guidelines, from the American College of Chest Physicians, the British Thoracic Society, and the European Respiratory Society with the European Society of Thoracic Surgery, and summarized other published studies. Drawing on those sources, they described checking heart risk first, then breathing tests (FEV1 and DLco), and then exercise tests when lung function is reduced. They cited an English national audit that reported thirty-day mortality of 2.3% after lobectomy and 7% after pneumonectomy. The authors concluded that a multidisciplinary approach is essential for patients with marginal lung function.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative mini review of clinical guidelines and published studies on preoperative assessment for lung cancer surgery; no original data
• Who was studied: No study population. The review covered lung cancer patients being considered for surgical resection, as described in three guideline documents (ACCP, BTS, ERS/ESTS) and other published studies.
• Exposure: Asbestos was not studied. The abstract and the introduction each mentioned it briefly, with the introduction citing another study, as one of several agents associated with lung cancer besides cigarette smoking. The other agents listed were heavy metals, radon and particulate air pollution.
• Main results:
  • Citing other studies, the review stated that surgical resection rates for lung cancer patients are low, approximately 20-30%.
  • Citing data from the National Lung Cancer Audit in England (2004 to 2010, 10,991 patients), the review reported thirty-day mortality of 2.3% for lobectomy and 7% for pneumonectomy.
  • The review stated that the guidelines agree cardiovascular evaluation should be the first step of preoperative assessment.
  • Citing the guidelines, the review stated that patients with preoperative FEV1 and DLco above 80% predicted, or predicted postoperative FEV1 and DLco above 60% predicted, are considered low risk, even for pneumonectomy.
  • Citing other studies, the review stated that patients with VO2 max above 20 mL/kg/min or above 75% predicted could undergo even pneumonectomy. Those with VO2 max below 10-12 mL/kg/min or below 35% predicted were described as a high-risk group for whom major anatomic resection is contraindicated.
• The authors' conclusion: The authors concluded that a multidisciplinary approach is essential to reduce perioperative morbidity and mortality in patients with marginal lung function reserves. They listed smoking cessation, VATS lobectomy, lung volume reduction surgery in selected COPD patients, and pulmonary rehabilitation as supportive options.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Occupational Exposure, Neoplasm, COPD, Surgical Resection, Thoracic Surgery.

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