Study objectives: To assess (1) the possibility of
predicting long-term postoperative lung function, and (2) the
usefulness of maximal oxygen consumption
(V̇o2max) as a criterion for operability
and as a predictor of long-term disability.
Setting: Outpatients and inpatients
of a university hospital.
consecutive patients (mean ± SD age, 62 ± 8 years; 51 male and 11
female patients) were preoperatively evaluated for lung cancer
resection (pneumonectomy or bilobectomy [n = 14] and lobectomy[
n = 48]).
Measurements: Clinical examination and
recorded respiratory symptoms and spirometry results before surgery and
6 months after surgery. If predicted postoperative FEV1
(ppoFEV1) was < 40%, patients underwent exercise
testing; if V̇o2max was between 10
mL/kg/min and 20 mL/kg/min, patients underwent a split-function
Results: All the patients with
ppoFEV1 ≥ 40%—even those patients (26%) with
FEV1 < 80%—underwent thoracotomy without further tests.
Seven patients with ppoFEV1 < 40% underwent exercise
testing, and three of them underwent a split-function study. Nine
patients (15%; including six patients with COPD and one patient with
asthma) had immediate postoperative complications (pneumonia[
n = 5] and respiratory failure [n = 4]); seven of these
patients had ppoFEV1 ≥ 40%. ppoFEV1
significantly underestimated the actual postoperative FEV1
(poFEV1; p < 0.001) 6 months after pneumonectomy or
bilobectomy but was reliable for actual poFEV1 after
lobectomy. Two patients with predicted postoperative
V̇o2max > 10 mL/kg/min became oxygen
dependent and had marked limitation of daily living.
Conclusions: ppoFEV1 ≥ 40% reliably
identifies patients not requiring further tests and not at long-term
risk of respiratory disability. V̇o2max,
effective for defining the immediate surgical risk, is not useful in
predicting long-term disability.