Use of radionuclide scanning in the preoperative estimation of pulmonary function after pneumonectomy.

Corris, PA; Ellis, D A; Hawkins, T; Gibson, G J

doi:10.1136/thx.42.4.285

Cited by 109 publications

(70 citation statements)

References 20 publications

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“…In 1987, CORRIS et al [124] and, recently, PUENTE-MAESTU et al [125], showed that using Olsen's perfusion scan formula they were able to predict postoperative exercise capacity (V 'O 2 ,max-ppo). At our institution, BOLLIGER et al [48] recently studied a group of 25 patients with impaired pulmonary function using this formula to predict V 'O 2 ,max-ppo; and very good correlations were found between predicted and measured postoperative values.…”

Section: Split-function Studiesmentioning

confidence: 99%

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: Split-function Studiesmentioning

confidence: 99%

Functional evaluation of the lung resection candidate

Bolliger¹,

Perruchoud²

1998

Eur Respir J

161

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“…5 However, reaching a definitive conclusion about predicting postoperative pulmonary function was difficult in most of these studies because they were based on small samples and short monitoring periods (3 or 6 months at the longest). [6][7][8] Furthermore, surgical techniques and postoperative care have steadily improved since these studies were performed.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Function Changes Over 1 Year After Lobectomy in Lung Cancer

et al. 2015

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BACKGROUND: This study was conducted to measure the serial changes in pulmonary function over 12 months after lobectomy in subjects with lung cancer and to evaluate the actual recovery of pulmonary function in comparison with the predicted postoperative values. METHODS: Subjects who underwent lobectomy for primary lung cancer were included in this study. In the statistical analysis, we included data from 76 subjects (52 men and 24 women; mean age, 63.4 y) who completed perfusion scintigraphy 1 week before surgery and FEV 1 and diffusion capacity of the lung for carbon monoxide (D LCO ) assessments preoperatively and at 1, 6, and 12 months postoperatively. RESULTS: The actual percent-of-predicted FEV 1 1 month postoperatively was 77.9% of the preoperative value, which was almost equal to the predicted postoperative value, and significantly increased to 84.3% by 6 months and 84.2% at 12 months. The actual percent-of-predicted D LCO 1 month postoperatively was 81.8% of the preoperative value, which was similar to the predicted postoperative value, and also significantly increased to 91.3% at 6 months and 96.5% at 12 months. However, the actual pulmonary function test results at 1 y in subjects with COPD or in those who underwent thoracotomy or received adjuvant chemotherapy were not different from the predicted postoperative values. CONCLUSIONS: Actual pulmonary function compared with predicted postoperative values improved over time over 1 y after lobectomy. However, this improvement was not observed in subjects with COPD or in those who underwent thoracotomy or received postoperative adjuvant chemotherapy.

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“…If these requirements are not met, a perfusion or ventilation scan is performed, and the predicted postoperative FEV1 (FEV1,ppo) is estimated. The accuracy of these methods is proven [7][8][9][10][11] and it seems generally accepted that a FEV1,ppo of 0.8-1.0 L or 30% pred represents the lower limits of acceptable risk [4][5][6][12][13][14][15][16][17]. Some recommend different limits for different resections [18].…”

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confidence: 99%

Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma

Larsen¹,

Ug²,

Milman³

et al. 1997

Eur Respir J

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The aim of this study was to evaluate which parameters of preoperative spirometry and cardiopulmonary exercise test are the best predictors of postoperative morbidity and mortality in patients with bronchogenic carcinoma.Ninety seven patients were prospectively and consecutively examined. All patients had preoperative maximal exercise test and dynamic spirometry. Postoperative complications and causes of death were registered. Logistic regression was used and models explaining the relationship between preoperative variables and postoperative complications and deaths were constructed.We found significant differences in preoperative maximal workload and carbon dioxide output between groups, with and without cardiopulmonary-related complications, but not in spirometry variables. Logistic regression showed maximal workload to be the only predictor of cardiopulmonary complications. Maximal oxygen uptake was predictive of cardiopulmonary deaths. Maximal oxygen uptake and forced expiratory volume were predictive of postoperative complications. A maximal oxygen uptake <50% predicted was associated with high risk of death from cardiopulmonary causes. Kaplan-Meier survival curves showed that maximal oxygen uptake was correlated to long-term survival, while spirometric variables were not.Exercise testing can be used in the preoperative evaluation of patients with nonmetastatic bronchogenic carcinoma. A combination of the results of variables from spirometry and exercise testing is proposed to be used as a preoperative criterion for operability. Eur Respir J 1997; 10: 1559-1565 Carcinoma of the lung is one of the most common causes of death due to cancer in men, and is increasingly common in women. Some 900,000 new cases are reported worldwide every year [1]. The prognosis in untreated cases is poor, and at present the major curative treatment modality for non-small cell carcinoma is resection. The removal of lung parenchyma from patients, who are usually smokers with compromised cardiovascular or pulmonary status, may lead to cardiopulmonary failure or death. Many variables have been used to assess the risk of postoperative complications, but it is not clear which of these parameters in preoperative pulmonary function testing are the best predictors of the operative outcome. Many centres recommend operation without additional testing in patients with a forced expiratory volume in one second (FEV1) >2.0 L or 60% of predicted and a diffusing capacity >60% pred [2][3][4][5][6]. If these requirements are not met, a perfusion or ventilation scan is performed, and the predicted postoperative FEV1 (FEV1,ppo) is estimated. The accuracy of these methods is proven [7][8][9][10][11] and it seems generally accepted that a FEV1,ppo of 0.8-1.0 L or 30% pred represents the lower limits of acceptable risk [4][5][6][12][13][14][15][16][17]. Some recommend different limits for different resections [18]. In spite of this consensus for identifying patients at risk, about 30% develop cardiopulmonary complications with a 30 day mortal...

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Use of radionuclide scanning in the preoperative estimation of pulmonary function after pneumonectomy.

Cited by 109 publications

References 20 publications

Functional evaluation of the lung resection candidate

Functional evaluation of the lung resection candidate

Pulmonary Function Changes Over 1 Year After Lobectomy in Lung Cancer

Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma

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