Assessment of Operative Risk in Thoracic Surgery

Mittman, Charles

doi:10.1097/00132586-196304000-00010

Cited by 19 publications

(25 citation statements)

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“…In a recent paper by MILLER [17], reporting on 2,340 patients, the suggested FEV1 values were >2 L for pneumonectomy, >1 L for lobectomy, and >0.6 L for wedge or segmental resections. Three reports used the FEV1 in percentage predicted: MITTMAN [18] suggesting >70%, NAGASAKI et al [19] and, most recently, PATE et al [20], >40%; however, none of the three studies mentioned the extent of resection possible with these values. PATE et al [20] suggested >1.6 L for absolute FEV1 values.…”

Section: Spirometrymentioning

confidence: 99%

“…Static lung volumes measured by helium diffusion or body plethysmography have been suggested to appreciate the extent of overinflation as a potential risk factor. Recommendations for the residual volume (RV) vary, SCHAEFER et al [23] recommending <2 L and BAGG et al [24] <2.5 L. For the ratio between RV and total lung capacity (TLC) (RV/TLC), recommendations are <40% [25,26] and <50% [18,[27][28][29] The plethysmographically determined airway resistance for a pneumonectomy should be <0.5-0.8 kPa (<5-8 mbar·L -1 ·s) according to certain authors [13,26,30,31]. All of these measurements of maximal flows, static lung volumes and airway resistance have been abandoned over time.…”

Section: Spirometrymentioning

confidence: 99%

“…As early as 1961, MITTMAN [18] showed that an abnormal electrocardiograph (ECG) was associated with an increased risk of suffering an intraoperative or postoperative cardiac event, defined as heart failure, arrhythmias or myocardial infarction. In patients with bronchogenic carcinoma, DIDOLKAR et al [49] found a postoperative mortality of 9.1% when the ECG was normal but 21.9% when it was pathological.…”

Section: Cardiac Riskmentioning

confidence: 99%

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Functional evaluation of the lung resection candidate

Bolliger¹,

Perruchoud²

1998

Eur Respir J

161

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Advances in operative technique and perioperative care have considerably reduced surgical morbidity and mortality after pulmonary resections. Various single and combined parameters of functional operability have been proposed to assess the surgical risk. Pulmonary function tests adequately assess the pulmonary risk, and baseline or stress electrocardiography, echocardiography and nuclear cardiac studies assess the cardiac risk.Patients with normal or only slightly impaired pulmonary function (forced expiratory volume in one second (FEV1) and transfer factor of the lung for carbon monoxide (TL,CO) ≥80% of predicted) and no cardiovascular risk factors can undergo pulmonary resections up to a pneumonectomy without further investigation. For others, exercise testing, pulmonary split-function studies, or a combination of these two methods are recommended. Exercise testing, most frequently performed as a symptom-limited test with the measurement of maximal oxygen uptake (V 'O 2 ,max), assesses both the pulmonary and cardiovascular reserves. A V'O 2 ,max of <10 mL·kg -1 ·min -1 is generally considered prohibitive for any resection, a value of >20 mL·kg -1 ·min -1 or >75% of predicted normal, safe for major resections. Split-function studies are radionuclide-based estimations of the predicted postoperative (ppo) values of various parameters. The currently used ppo-parameters are FEV1-ppo, TL,CO-ppo and, most recently, V'O 2 ,max-ppo. Suggested cutoff values for safe resection are: for FEV1-ppo and TL,CO-ppo ≥40% pred; and for V 'O 2 ,max ≥35% pred, combined with an absolute value of ≥10 mL·kg -1 ·min -1 . The lowest acceptable ppo-values will still have to be established by additional prospective studies.In the long-term, resections involving not more than one lobe usually lead to an early functional deficit followed by later recovery. The permanent functional loss in pulmonary function is small (≤10%) and exercise capacity is only slightly reduced or not at all. Pneumonectomy, on the other hand, leads to an early permanent loss of about 33% in pulmonary function and 20% in exercise capacity. Thus, pulmonary function tests alone overestimate the functional loss after lung resection. Eur Respir J 1998; 11: 198-212 The dramatic increase in the incidence of bronchogenic carcinoma has made this disease the most frequent malignancy worldwide. In industrialized nations, the majority of lung resection candidates suffer from bronchogenic carcinoma, whereas only some decades ago benign conditions, such as destroyed lung parenchyma after tuberculosis, had to be removed. The prognosis of bronchogenic carcinoma remains sombre as about 75-85% are inoperable at the time of diagnosis [1], and despite recent advances in chemo-and radiotherapy regimens, surgical resection remains the only curative form of treatment [2].Depending on their extent, pulmonary resections lead to permanent loss of pulmonary function. In healthy people, resections up to a pneumonectomy are tolerated remarkably well. Lung cancer patients, however, are...

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Section: Spirometrymentioning

confidence: 99%

Section: Spirometrymentioning

confidence: 99%

Section: Cardiac Riskmentioning

confidence: 99%

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Functional evaluation of the lung resection candidate

Bolliger¹,

Perruchoud²

1998

Eur Respir J

161

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“…Mittman (1961) concluded that the postoperative mortality after lung resection correlated better with the preoperative lung function than with the amount of lung resected, and Filley (1966) said that patients with only moderately reduced pulmonary function are at greatest risk because their danger goes unrecognized without pulmonary function measurement.…”

Section: -4 39-8 Nsmentioning

confidence: 99%

“…Some have advocated analysis of tests of maximum ventilatory function (Woodruff, Merkel, and Wright, 1953;Bergan, 1956;Pecora, 1962), while others have been unimpressed by the value of these measurements (Larsen and Cliffton, 1965;Karliner, Coomaraswamy, and Williams, 1968). Mittman (1961) found that where the RV/TLC% was greater than 50, the postoperative mortality rate was 36%, whereas when this ratio was less than 40, the mortality rate was only 8%.…”

Section: -4 39-8 Nsmentioning

confidence: 99%

Pulmonary function in bronchial carcinoma

Legge

Palmer

1973

Thorax

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Legge, J. S., and Palmer, K. N. V. (1973). Thorax, 28,[588][589][590][591] To determine the lung volumes, the functional residual capacity (FRC) was measured in duplicate by the closed-circuit multiple breath helium dilution method, and after measuring the inspiratory capacity and expiratory reserve volume, the total lung capacity (TLC), residual volume (RV), and RV/TLC% were calculated in litres (ATPS).Single breath carbon monoxide transfer factor *(TF) (ml/mmHg/min) was measured in duplicate by the method of Ogilvie, Forster, Blakemore, and Morton (1957).Arterial blood samples were obtained with the patient breathing air and the arterial oxygen tension (Pao2) (mmHg) and carbon dioxide (Paco2) (mmHg) were measured in duplicate using electrodes by Radiometer, Copenhagen.

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Present-Day Risk of Thoracotomy in Patients With Compromised Pulmonary Function

Bryant¹

1970

Arch Surg

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Assessment of Operative Risk in Thoracic Surgery

Cited by 19 publications

References 0 publications

Functional evaluation of the lung resection candidate

Functional evaluation of the lung resection candidate

Pulmonary function in bronchial carcinoma

Present-Day Risk of Thoracotomy in Patients With Compromised Pulmonary Function

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