Optimization of lung function before pulmonary resection: pulmonologists' perspectives
Section snippets
Chronic obstructive pulmonary disease
Most lung resections are performed for bronchogenic carcinoma, for which the major risk factor is tobacco smoking. Tobacco smoking also is the major risk factor for the development of COPD. Most candidates for resection for lung cancer have COPD with its attendant functional impairment. Because the only known cure for non–small cell bronchogenic carcinoma currently is surgery, the concern of the pulmonologist and the surgeon is determining which patients can tolerate the necessary removal of
Other risk factors
Many preoperative risk factors, other than those related to pulmonary function, have been identified. COPD itself has been found to be a risk factor in some studies [8], [9], but not all studies [10]. Similarly the presence of interstitial lung disease was found to increase the risk of resection in one study [32], but not in others [33], [34]. In these latter studies, mortality and survival were the same as for lung cancer in general or interstitial lung disease in general. Asthma is not a risk
Preoperative optimization of function and reduction of risk
With the understanding of the above-outlined preoperative risk factors, measures can be taken to reduce surgical risks. Focusing on COPD, several areas can be optimized. Bronchitic infections, manifested by increased cough and sputum production, can be treated with a course of antibiotics with improvement in postoperative outcomes [51], [52]. Bronchospastic exacerbations of COPD or asthma can be treated with bronchodilators and corticosteroids preoperatively, perioperatively, and
Future research
Although much information has become available with respect to COPD, comparable information is needed for the effects of resection on patients with interstitial lung disease. The need for prediction of postoperative lung function and the accuracy of these predictions in the presence of interstitial lung disease are not known. The presence of significant pulmonary hypertension can be assumed to present a risk similar to that in COPD, but in both cases a tolerable level (if any) of pulmonary
Summary
Many risk factors for morbidity and mortality with lung resection have been identified. Factors such as age, gender, and cancer stage cannot be altered, but lung function can be optimized by treating COPD or asthma with bronchodilators, corticosteroids, or antibiotics (when indicated) and by inspiratory muscle training. Although smoking cessation 2 months in advance of surgery may not be feasible, cessation nevertheless should be encouraged because it may decrease postoperative inflammation and
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