Pulmonary function tests in the preoperative evaluation of lung cancer surgery candidates. A review of guidelines

International expert consensus on diagnosis and treatment of lung cancer complicated by chronic obstructive pulmonary disease

Background

Lung cancer combined by chronic obstructive pulmonary disease (LC-COPD) is a common comorbidity and their interaction with each other poses significant clinical challenges. However, there is a lack of well-established consensus on the diagnosis and treatment of LC-COPD.

Methods

A panel of experts, comprising specialists in oncology, respiratory medicine, radiology, interventional medicine, and thoracic surgery, was convened. The panel was presented with a comprehensive review of the current evidence pertaining to LC-COPD. After thorough discussions, the panel reached a consensus on 17 recommendations with over 70% agreement in voting to enhance the management of LC-COPD and optimize the care of these patients.

Results

The 17 statements focused on pathogenic mechanisms (n=2), general strategies (n=4), and clinical application in COPD (n=2) and lung cancer (n=9) were developed and modified. These statements provide guidance on early screening and treatment selection of LC-COPD, the interplay of lung cancer and COPD on treatment, and considerations during treatment. This consensus also emphasizes patient-centered and personalized treatment in the management of LC-COPD.

Conclusions

The consensus highlights the need for concurrent treatment for both lung cancer and COPD in LC-COPD patients, while being mindful of the mutual influence of the two conditions on treatment and monitoring for adverse reactions.

Can functional inoperability in lung cancer patients be changed by pulmonary rehabilitation?

Background

This study aims to investigate the effects of shortterm intense pulmonary rehabilitation on respiratory function in patients with lung cancer who were defined as inoperable due to insufficient pulmonary reserve.

Methods

A total of 25 patients (24 males, 1 female; mean age 62 years; range, 50 to 72 years) who were histologically diagnosed as non-small cell lung carcinoma, considered functionally inoperable due to high risk of an estimated postoperative complication, and suitable for surgical resection according to tumor stage were included in the study. Patients received chest physiotherapy, self-walking and inspiratory muscle training for two weeks. The forced expiratory volume in one second, forced vital capacity, modified Medical Research Council dyspnea scale, six-minute walking distance, maximal inspiratory and expiratory pressures for respiratory muscle strength measurements, and predicted peak maximal oxygen consumption were examined.

Results

After pulmonary rehabilitation, there was statistically significant improvement in the six-minute walking distance (53 m, p<0.001), dyspnea perception (p<0.001), maximal inspiratory pressure (12 cm H₂O, p<0.001), forced vital capacity (p<0.001), predicted forced expiratory volume in one second (%) (p=0.001), forced expiratory volume in one second (Δ forced expiratory volume in one second= 150 mL, p=0.001; Δ maximum value of forced expiratory volume in one second: 650 mL), and predicted maximal oxygen consumption (p<0.001). At the end of the rehabilitation, 60% of the patients (n=15) reevaluated by the surgeons could be operated.

Conclusion

Short-term intensive pulmonary rehabilitation improves lung functions and exercise capacity while decreasing dyspnea perception. In our study, thanks to the gains derived from the exercise, approximately more than half of the patients could be operated. Therefore, it may be useful to refer patients to rehabilitation before establishing a decision of inoperability.