Rays
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Review
Preoperative assessment and risk factors in the surgical treatment of lung cancer: the role of age.
The incidence of lung cancer in the elderly is increasing in Western countries. This disease represents the second leading cause of cancer death in this age group and it is also responsible for a substantial increment in morbidity and health care costs. ⋯ Therefore, a careful preoperative assessment of these factors, with particular regard to comorbid conditions (such as cardiovascular and pulmonary diseases or secondary malignancy) is necessary in older adults. In consideration of the need of a multidisciplinary assessment to identify comorbidities and operative risk a close collaboration between pneumologists, radiologists, oncologists, thoracic surgeons, anesthesiologists, cardiologists, geriatric specialists, physical therapists is highly recommended.
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Abstract. Radiotherapy was the standard treatment for patients with locally advanced non-small cell lung cancer until the mid 1990s. ⋯ Goals of neoadjuvant chemoradiation are resecability and downstaging. Recent published experiences evidenced that neoadjuvant chemoradiotherapy is feasible if delivered with low total dose and limited volume; pathological downstaging to stage 0-I could be a reasonable surrogate end-point for overall and disease free survival and for distant metastasis.
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Surgery, when feasible, rappresents the treatment of choice for lung cancer. Several problems can come to the attention of the anesthesiologist in relation to the respiratory function with implications in airway control (double-lumen tube for lung collapse required for better surgical exposure of the pulmonary tissue), mechanical and gas-exchange aspects (increase in airway pressure of the dependent lung, increased blood shunt). ⋯ Right heart failure is the major risk particularly in preexisting pulmonary hypertension Supraventricular arrytmias can often occur in case of history of cardiovascular disease, metabolic and mechanical intraoperative alterations (type and duration of surgery, pericardial and autonomic nervous system manipulations). Unusual complications are cardiac herniation and pulmonary re-expansion-edema.
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Based on a review of the literature on resectable lung cancer, pulmonary risk factors before, during and after surgery are discussed. The role of preoperative evaluation in order to determine the patient ability to withstand radical resection is considered. Spirometric indexes as forced expired volume (FEV1) and diffusing lung carbon monoxide capacity (DLCO) should be measured first. ⋯ However, if FEV1 and DLCO are <60% of predicted, further evaluation with a quantitative lung scan is required. If predicted postoperative values for FEV1 and DLCO are >40%, patients can undergo lung resection, otherwise exercise testing is necessary. If the latter shows maximal oxygen uptake (VO2max) of > 15ml/Kg, surgery can be performed; if VO2max is <15 ml/Kg, patients are inoperable.