Preoperative assessment of patients for lung cancer surgery

PURPOSE OF REVIEW: The aim of this work was to present and analyze the latest published documents about the functional evaluation of patients undergoing lung resection and review articles from the past two years addressing the same topic. RECENT FINDINGS: In 2009 and 2010, two important task forces, appointed by international scientific societies, have published documents to guide the preoperative evaluation and risk stratification of lung resection candidates. In both documents, cardiac evaluation is prioritized. Detailed cardiologic guidelines have been proposed. After this first step, functional assessment should include a spirometric assessment, asystematic measurement of carbon monoxide diffusion capacity and a cardiopulmonary exercise test evaluation. Differences in the relative importance of these tests in the two guidelines were discussed. Most recent evidences focused on the role of cardiopulmonary exercise test and the use of several direct and indirect ergometric parameters that may refine risk assessment. SUMMARY: The use of evidence-based clinical guidelines on preoperative evaluation is recommendable. Nevertheless, scientific evidence is still suboptimal in this field. Aggregate analyses on larger series are needed to improve risk stratification.