Thoracic Surgery Highlight: Understanding the Terminology with Preoperative Pulmonary Function Tests in Lung Resection Candidates

October 28, 2018

By Margaret Holland, PA-C
AASPA Director of Education

Lung cancer remains the leading cause of cancer death in the United States, with an estimated 234,030 new cases of lung cancer expected to be diagnosed in the US in 2018.(1) Surgery remains the mainstay of treatment for early-stage non-small cell lung cancers with procedures such as the wedge resection (segmentectomy), lobectomy, and pneumonectomy. Currently, surgical mortality rates are typically estimated between 1-5% depending on the procedure performed. Due to the proximity of the lungs to the diaphragm, use of volatile anesthetic agents, and pain from surgery, patients undergoing lung resections are at high risk for postoperative pulmonary complications. When planning for surgery, lung function testing is valuable when considering the risk of mortality and decreased postoperative lung function.

It is recommended by the American College of Chest Physicians (ACCP) and the British Thoracic Society (CTS) that preoperative pulmonary function be assessed in all patients with lung cancer being considered for resectional surgery. The initial assessment should include spirometry to measure the forced expiratory volume in one second (FEV1) and the diffusion capacity for carbon monoxide, which is abbreviated DLCO.(2) The predicted postoperative values should also be calculated. These are are the least invasive tests available that can be utilized to assess risk of both preoperative complications and longterm disability from surgical intervention.

The terminology and meaning associated with these tests can be confusing, especially if we do not regularly utilize them in daily practice. The following is a clarification of these terms and acronyms, and how they help guide our management of the patient undergoing preoperative evaluation for lung resection.

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