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Introduction: Despite advances in surgical techniques and anaesthetic management in lung cancer surgery, cardiopulmonary complications are the most important causes of postoperative morbimortality. The aim of this study was to evaluate Cardiopulmonary Exercise Test (CPET) parameters as predictors of postoperative complications in lung cancer surgery patients. Method: This observational prospective study included patients who were candidates for lung cancer surgery (LCS) at our hospital. Patients with either a post-bronchodilator FEV1% or DLCO Results: 118 patients were included, (71% men); mean age was: 66 + 10 years; mean FEV1 (%): 69 ± 14 and mean DLCO (%) = 68 ± 16. The mean VO2 max (ml/kg/min) was 18 ± 4. The incidence of complications was 16% (84.8% of total complications were respiratory). Table 1 shows the clinical, functional and CPET characteristics of patients according to the presence of complications. After adjusting for perioperative factors by logistic regression, the best predictor factors of postoperatorive total complications were exercise VE/VCO2 slope and VE max (OR: 1,12, p=0,018; OR: 0,95; p=0,019, respectively). For postoperative respiratory complications, the best predictor factors were VO2 max and FEV1/FVC (OR=0.751, p=0.003; OR=0.932, p=0.006, respectively) Conclusions: The predictive capacity of VO2 max and VE/VCO2 for postoperative morbidity supports the use of CPET as a tool to improve the stratification of risks in lung cancer patients. These results reaffirm the inclusion of the CPET in the first steps of preoperative risk assessment algorithms.

Introduction: The maximal oxygen consumption obtained in a cardiopulmonary exercise test (CPET) is a good predictor of the risk in lung cancer surgery. Clinical practice guidelines differ with regard to the indication of CPET. The aim of this study was to compare the algorithms proposed in the guidelines of the European Respiratory Society (ERS/ESTS)* and the American College of Chest Physicians (ACCP)**. Methods: This observational prospective study included patients who were candidates for lung cancer surgery (LCS) at our hospital. Patients with either a post bronchodilator FEV1% or diffusing capacity of carbon monoxide (DLCO) Results: A total of 125 CPET were performed. The overall diagnostic concordance between algorithms was 72% (Kappa index= 0.31; p= 0.000). For the assessment of “low risk” (surgery until pneumonectomy) the algorithms coincided in 64.8% of cases. 18.4% of patients were classified as “low risk” according to the ACCP and as “moderate risk” by the ERS/ESTS (surgery until lobectomy). According to the ACCP, 15 patients were classified as “high-risk” (proposed surgery not recommended/atypical or minor surgery). According to the ERS/ESTS, five of these 15 patients were classified as “moderate risk” and seven as “low risk”. Conclusions: The ERS/ESTS algorithm is more conservative for patients who are candidates for major lung resection. It allows LVRS in patients with pulmonary function alteration who would have been rejected according to the ACCP. * Eur Respir J 2009; 34: 17-41 ** Chest 2007; 132; 161S-177S