Exercise testing in the evaluation of patients at high risk for complications from lung resection

Exercise testing was performed on 37 patients with resectable lung lesions who were deemed inoperable because of any of the following risk factors: (1) FEV₁ ≤40 percent of predicted; (2) radionuclide calculated postlobectomy FEV₁ ≤33 percent of predicted; or (3) arterial PCO₂ ≥45 mm Hg. The patients who reached a peak level of oxygen consumption during exercise (V̇O(2Peak)) of ≥15 ml/kg/min were offered surgical treatment. Patients with a V̇O(2Peak) of <15 ml/kg/min were referred for nonsurgical management and excluded from the study. Eight patients underwent lung resection. Their pulmonary function revealed a severe obstructive lung defect with a group mean predicted FEV₁ of 40±6 percent, an FEV₁/FVC ratio of 47±10, a radionuclide calculated postlobectomy FEV₁ of 31±4 percent, and a mean arterial PCO₂ of 44±6 mm Hg. No relationship was found between each patient's exercise performance and spirometric function. Six of the patients had an uncomplicated postoperative course. Two patients had complications but no patient died as a result of surgery or postoperative complications. All patients were discharged from the hospital within 22 days (mean=9.8 days). We conclude that exercise testing is a useful complement to conventional cardiopulmonary evaluation used in selecting patients for lung resection.