MANAGEMENT OF CANCER3
at the initial stage. However, patients above 80 years of age are not included in this as they
cannot be subjected to any lobectomy. Evaluating pulmonary function is important to check
the presence of any interstitial lung disorder or disability, causing shortness of breath.
Presence of endobronchial lesions is an important parameter for consideration before surgery.
The oxygen saturation of the patient at rest on-air must be measured. Also, the post-
bronchodilator FEV1>1.5 litres for a successful lobectomy FEV1>2.0 for pneumonectomy.
Cardiovascular fitness is determined with a preoperative ECG of the patient. Patients with a
medical history of myocardial infarction, coronary artery bypass surgery and an audible
cardiac murmur must take the opinion of a cardiac expert. Patients with a history of stroke or
presenting a preoperative weight loss of more than 10% require a critical valuation for
surgery.
Risk scores of postoperative mortality and morbidity
Modern surgical practices have demonstrated a considerable reduction in
postoperative complications and mortality. These refined techniques such as muscle-sparing,
robotically assisted lung resection and intercostal nerve-sparing thoracotomy are currently
used in surgery. Postoperative morbidity increases with age and is more prevalent in the
elderly. Evidence suggests that morbidity, specifically cardiovascular increases with the
growing age of the patient and require intensive care. Another interesting risk factor is the
clinical stage of the disease. Postoperative survival beyond stage III is poor. Inefficient
pulmonary function poses a high risk of long-term disabilities post-operation. It is an
essential parameter of risk calculation for patients with pre-existing pulmonary disorders and
stable on high doses of medication. Reports state that risks associated with resection are a
function of estimated postoperative FEV1 and the latter expressed as % predicted. A threshold
range of 34-45% predicted approved for operation. Reduced values of FVE1 or predicted
postoperative FVE1 is followed by increased risks of respiratory morbidity or mortality. Risk

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