Introduction Lung cancer is the most common
Lung cancer is the most common and deadly malignancy in Taiwan, the cause of an estimated 33,919 new cases between 2002 and 2008. Although the 5-year survival rate is only 15.9%, the overall survival rate is as high as 60.7% in patients whose tumors are confined to the primary site at time of diagnosis. Unfortunately, this number only accounts for just 12.5% of the patients, and only 16.4% patients received surgical resection with a median survival of 13.2 months.
Anatomic resection with radical polo-like kinase 1 node dissection is a curative treatment for lung cancer. There is a significant difference between the 5-year survival rate of patients who underwent surgery (57.2%) and those who did not receive surgical intervention (7.5%), according to the published data in Taiwan. Patients who underwent lobectomy have a higher 5-year survival rate compared with patients who underwent other surgical procedures.
Given the relatively poor prognosis for patients with lung cancer who cannot be treated surgically, every effort should be made to increase the number of patients eligible for surgery. Approximately 73% of men and 53% of women are diagnosed with chronic obstructive pulmonary disease (COPD) along with lung cancer. These patients often have hyperinflation and increased labored breathing which leads to decreased activity levels, subsequent muscle deconditioning and poor exercise tolerance. Surgery in these patients can be associated with increased risk of morbidity and mortality after lung resection. For lung cancer patients with no underlying chronic respiratory disease, physical symptom burden, fatigue and performance status may have a negative effect on general function and poor postoperative outcomes.
Preoperative evaluation Surgical options in cases of lung cancer include pneumonectomy, lobectomy or sub-lobar resection, and are available for patients who are eligible for surgery. The advantages of limited pulmonary resection are in part the ability to preserve a greater amount of lung volume and reducing the risk of physiological impairment after surgery. Although surgery is the best option for treating patients with early-stage non-small-cell lung cancer (NSCLC), abnormal pulmonary function still occurs in patients with potentially resectable tumors. These patients may be at an increased risk of both immediate perioperative complications and long-term disability following surgical resection. The level of acceptable risk for postoperative complications is somewhat subjective, and efforts persist to ensure the best predictive tests and define the threshold values necessary for minimizing surgical risk. Consequently, in considering whether the patient should undergo curative-intent surgical resection of lung cancer, the possible short-term perioperative risk from comorbid cardiopulmonary disease and the long-term risk of pulmonary disability must be balanced against the possible risk of reduced survival if an oncological suboptimal treatment strategy is chosen. The task of the preoperative assessment is to identify patients at an increased risk of both perioperative complications and long-term disability from lung cancer. This assessment is essential to allow communication between clinicians and their patients about treatment options and risks, so secondary extinction informed decisions can be made. Preoperative functional evaluation is deemed necessary for all types of operations. Diffusing capacity of the lung (DLCO), one of the most clinically valuable tests of lung function, was established for predicting postoperative complications in patients with normal Forced Expiratory Volume in One Second (FEV1). The clinicians should not ignore the assessment of exercise capacity and Maximum Oxygen Uptake (VO2 max), which has been proven to be inversely correlated with post-operative morbidity and mortality, as shown by the guidelines laid down by the European Respiratory Society and the European Society of Thoracic Surgeons joint task force. The suggested tests include measurement of preoperative pulmonary function, calculation of predicted postoperative pulmonary function, measures of gas exchange, and exercise testing.