Preoperative functional assessment of patients who are scheduled to undergo pulmonary resection for carcinoma of the lung can assist the clinician in determining perioperative risk. Physiologic alterations that occur after thoracotomy, including changes in lung volume, ventilatory pattern, gas exchange, and respiratory defense mechanisms, impose an increased risk of complications in patients with moderate to severe respiratory impairment. The use and shortcomings of preoperative spirometry and arterial blood gas analysis as predictors of perioperative complications are reviewed. Quantitative radionuclide scintigraphy, and in some cases exercise testing, can further determine the operative risk of patients with lung cancer. For patients with increased risk, implementation of prophylactic measures may decrease postoperative complications.
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