Criteria of functional operability in patients with bronchial carcinoma: preoperative assessment of risk and prediction of postoperative function.

In this prospective study of 433 patients undergoing surgery for bronchial carcinoma 3 main factors influencing the operative risk were identified: (1) extent of resection, (2) pulmonary function and (3) age. The 30-day mortality rate was 8.3% in the whole group which comprised a high percentage of patients over 70 years of age (27%) and with a disturbed pulmonary function (45%). The value of various functional criteria proposed in the extensive literature is assessed and compared with the results of the study in which the use of FEV1 and quantitative regional analysis by perfusion scanning and 'regions of interest' proved to be highly efficient, allowing, in addition, the prediction of postoperative lung function even in sleeve resections. A new formula for estimation of the additional loss of function in the early postoperative phase after lobectomies is proposed along with a flow sheet for routine preoperative evaluation of pulmonary function.