Brunelli Alessandro, Rocco Gaetano, Varela Gonzalo
Unit of Thoracic Surgery, Umherto I Regional Hospital Ancona, Via S. Margherita 23, Ancona 60124, Italy.
Thorac Surg Clin. 2007 Aug;17(3):329-36. doi: 10.1016/j.thorsurg.2007.07.008.
In the last years a number of significant improvements have been achieved in risk stratification for lung cancer patients who undergo lung resection. Nevertheless, future improvements should be based in prospective cooperative studies including a large number of comparable cases. First limitations of available published evidence come from the fact that FEV1 and ppo-FEV1 are pivotal in patient classification. Besides, ppoFEV1 is not a reliable predictor of complications in patients with COPD, since their functional behavior is different compared with non-COPD patients after lung resection and, although current calculation methods may be accurate in estimating the residual definitive FEVI at 3 to 6 months after surgery, they tend to overestimate the actual FEV1 in the first postoperative days, when most of the complications occur. The assumption that FEV1 and DLCO are highly correlated is the reason why ppoDLCO estimation is not recommended in all patients, limiting the predictive ability of this test. Finally, the predictive ability of exercise testing has not been proven since it is not systematically recommended in all patients before lung resection.
在过去几年中，肺癌患者肺切除手术的风险分层取得了一些显著进展。然而，未来的改进应基于前瞻性合作研究，纳入大量可比病例。现有已发表证据的首要局限性在于，第一秒用力呼气容积（FEV1）和预计第一秒用力呼气容积（ppo-FEV1）在患者分类中至关重要。此外，ppoFEV1并非慢性阻塞性肺疾病（COPD）患者并发症的可靠预测指标，因为与肺切除术后的非COPD患者相比，他们的功能表现有所不同，而且尽管目前的计算方法在估计术后3至6个月的残余最终FEVI时可能准确，但在术后最初几天，即大多数并发症发生时，这些方法往往会高估实际的FEV1。FEV1与一氧化碳弥散量（DLCO）高度相关这一假设，是不建议对所有患者进行ppoDLCO评估的原因，从而限制了该检查的预测能力。最后，运动测试的预测能力尚未得到证实，因为在肺切除术前并非对所有患者都系统地推荐进行此项测试。
