The Significance of Exercise Test as a Predicting Index for the Complications from Lung Resection in Patients of Lung Cancer / 대한내과학회지

ABSTRACT

OBJECTIVES: Even resectable case under TNM staging criteria in lung cancer, poor pulmonary function makes surgical candidates inoperable and lung resection in patients with diminished cardiopulmonary reserve function is associated with increased perioperative morbidity and mortality, We planned to examine which can be the most important predicted determinants in asssessing preoperative routine check-up and/or exercise test in prospect of postoperative short-term complications. METHODS: Twenty two patients, taken lung resection under the diagnosis of an operable lung cancer were evaluated prospectively about not only the staging work-up, but also oxygen consumption and carbon dioxide production with treadmill test, and stair climbing. Control subjects were selected randomly from the thirty healthy person visiting health care center and examined general check-up together with spirometry and exercise test. The postoperative complications occurred within three months were included followings' arrhythmia requiring therapy, pneumonia, atelectasis, air-leak and/or pneumothorax, and death from the above reasons, RESULTS: Lung cancer group showed a significant decrease in FEV1, Bruce stage on treadmill test, and maximal oxygen consumption compared with normal control group. Comparison within groups according to complication showed significantly increased smoking history and significantly decreased FEV1 and FEV1 ppop in complicated group. In complicated group, the ratio of VO2max/VO2max, predicted was also decreased significantly, while the ICU day increased significantly. In complicated group, three cases among four with normal to mild pulmonary insufficiency on spirometry showed quite low VO2max level, CONCLUSION: These findings suggest that heavy smoking and diminished preoperative FEV1 in operable lung cancer are regarded as high risk factors, and it needs special concerns about postoperative complications when the ICU days is increasing. VO2max is thought to be an useful measurement in expecting postoperative complications, especially in cases of relatively good pulmonary function and further study will be needed for the more subjects in near future.