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Conclusions about Patient With Lung Cancer Being Considered for Resectional Surgery

Conclusions about Patient With Lung Cancer Being Considered for Resectional Surgery

Patients with lung cancer Patients with lung cancer often have concomitant diffuse parenchymal and/or obstructive airway disease and atherosclerotic cardiovascular disease as a consequence of their smoking habit. These diseases may place these patients at increased risk for perioperative complications, including death, and long-term pulmonary disability after lung cancer resection. A careful preoperative physiologic assessment will be useful to identify those patients who are at increased risk with standard lung cancer resection and to enable an informed decision by the patient about the appropriate therapeutic approach to treating their lung cancer. This preoperative risk assessment must be placed in the context that surgery for early-stage lung cancer is the most effective currently available treatment for this disease conducted with My Canadian Pharmacy.

Summary of Recommendations

1. It is recommended that patients with lung cancer be assessed for curative surgical resection by a multidisciplinary team, which includes a thoracic surgeon specializing in lung cancer, a medical oncologist, a radiation oncologist, and a pulmonologist.

Grade of recommendation, 1C

2. It is recommended that patients with lung cancer not be denied lung resection surgery on the grounds of age alone. Grade of recommendation, 1B

3. It is recommended that patients with lung cancer who are being evaluated for surgery and have major factors for increased perioperative cardiovascular risk have a preoperative cardiologic evaluation.

Grade of recommendation, 1C

4. In patients being considered for lung cancer resection, spirometry is recommended. If the FEV1 is > 80% predicted or > 2 L and there is no evidence of either undue dyspnea on exertion or interstitial lung disease, the patient is suitable for resection including pneumonectomy without a further physiologic evaluation. If the FEVj_ is > 1.5 L and there is no evidence of either undue dyspnea on exertion or interstitial lung disease, the patient is suitable for a lobectomy without further physiologic evaluation. Grade of recommendation, 1C

5. In patients being considered for lung cancer resection, if there is evidence of either undue dyspnea on exertion or interstitial lung disease, even though the FEV1 might be adequate, measuring Dlco is recommended. Grade of recommendation, 1C

6. In patients being considered for lung cancer resection, if either the FEVX or Dlco are < 80% predicted, it is recommended that postoperative lung function be predicted through additional testing. Grade of recommendation, 1C

7. In patients with lung cancer who are being considered for surgery, either an FEVX of < 40%PP0 or a Dlco of

< 40%PPo indicates an increased risk for perioperative death and cardiopulmonary complications with standard lung resection. It is recommended that these patients undergo exercise testing preoperatively. Grade of recommendation, 1C

8. In patients with lung cancer who are being considered for surgery, either a product of %PP0 FEVj_ and %PP0 Dlco of < 1,650%PP0 or an FEVX of < 30%PP0 indicates an increased risk for perioperative death and cardiopulmonary complications with standard lung resection. It is recommended that these patients should be counseled about nonstandard surgery and nonoperative treatment options for their lung cancer (find more information here). Grade of recommendation, 1C

9. In patients with lung cancer being considered for surgery, a Vo2max of < 10 mL/ kg/min indicates an increased risk for perioperative death and cardiopulmonary complications with standard lung resection. These patients should be counseled about nonstandard surgery and nonoperative treatment options for their lung cancer.

Grade of recommendation, 1C

10. Patients with lung cancer being considered for surgery who have a Vo2max of < 15 mL/kg/min and both an FEV1 and a Dlco of < 40%PP0 are at an increased risk for perioperative death and cardiopulmonary complications with standard lung resection. It is recommended that these patients be counseled about nonstandard surgery and nonoperative treatment options for their lung cancer. Grade of recommendation, 1C

11. Patients with lung cancer being considered for surgery who walk 45 mm Hg is not an independent risk factor for increased perioperative complications. However, it is recommended that these patients undergo further physiologic testing. Grade of recommendation, 1C

13. In patients with lung cancer who are being considered for surgery, an Sao2 of 20% predicted. Grade of recommendation, 1C

15. It is recommended that all patients with lung cancer be counseled regarding smoking cessation. Grade of recommendation, 1C

These articles can be useful for you:

Patient With Lung Cancer Being Considered for Resectional Surgery: Predicted Postoperative Lung Function

My Canadian Pharmacy about Patient With Lung Cancer Being Considered for Resectional Surgery: Risk of Long-term Pulmonary Disability

Patient With Lung Cancer Being Considered for Resectional Surgery: Methods To Reduce Perioperative Risks and Long-term Pulmonary Disability