Skip to main content
SpringerLink
Log in

Präoperative Evaluation und Risikoeinschätzung in der Thoraxchirurgie

Preoperative evaluation and risk estimation in thoracic surgery

  • Allgemeinanästhesie
  • Published:
Der Anaesthesist Aims and scope Submit manuscript

Zusammenfassung

Die präoperative Einschätzung der Lungenfunktion von Patienten vor lungenresezierenden Verfahren stellt eine interdisziplinäre Herausforderung dar. Trotz medizinischer Fortschritte in den Fachgebieten der Anästhesie, Intensivmedizin und Chirurgie liegt die Letalitätsrate von Patienten nach Pneumonektomie weiterhin bei 5–9%. Zur präoperativen Identifikation von Patienten mit einem erhöhten perioperativen Morbiditäts- und Letalitätsrisiko wurden Stufenschemata der präoperativen Evaluation der Lungenfunktion entwickelt, deren Basis die Spirometrie und die Messung der Diffusionskapazität darstellt. Bei Funktionseinschränkung folgen Messungen zur Einschätzung der postoperativen Lungenfunktion sowie die Bestimmung der maximalen Sauerstoffaufnahme zur präoperativen Risikostratifikation. Im Folgenden werden die Untersuchungsmethoden zur Erfassung von Lungenfunktionsparametern und Parametern des pulmonalen Gasaustausches beschrieben und deren Wertigkeit unter Berücksichtigung aktueller Leitlinien diskutiert.

Abstract

Preoperative evaluation of patients undergoing lung resection remains an interdisciplinary challenge. Despite substantial progress in anesthesiology, intensive care medicine and surgery, mortality of patients undergoing pneumonectomy remains high at 5–9%. Guidelines were developed to identify patients with an increased perioperative risk for morbidity and mortality. These guidelines are focused around the forced expiratory capacity (FEV) measured by spirometry, following further investigations in patients with limited FEV1. Extended testing includes measurement of the diffusion capacity, calculation of postoperative predicted values of lung function and spiroergometry to determine maximal oxygen uptake. In this article the methods to measure parameters of lung function and gas exchange are described and evaluated in the context of the current guidelines.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Brunelli A, Charloux A, Bolliger CT et al (2009) The European Respiratory Society and European Society Of Thoracic Surgeons clinical guidelines for evaluating fitness for radical treatment (surgery and chemoradiotherapy) in patients with lung cancer. Eur J Cardiothorac Surg 36(1):181–184

    Article  PubMed  Google Scholar 

  2. Kroidl RF, Schwarz S, Lehnigk B (2006) Cardiopulmonary exercise testing. Pneumologie 60(3):149–170

    Google Scholar 

  3. Colice GL, Shafazand S, Griffin JP et al (2007) Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2. Aufl.). Chest 132 [Suppl 3]:161–177

  4. British Thoracic Society, Society of Cardiothoracic Surgeons of Great Britain and Ireland Working Party (2001) BTS guidelines: guidelines on the selection of patients with lung cancer for surgery. Thorax 56(2):89–108

    Article  Google Scholar 

  5. Harbour R, Miller J (2001) A new system for grading recommendations in evidence based guidelines. BMJ 323(7308):334–336

    Article  CAS  PubMed  Google Scholar 

  6. McCrory DC, Lewis SZ, Heitzer J et al (2007) Methodology for lung cancer evidence review and guideline development: ACCP evidence-based clinical practice guidelines (2. Aufl.). Chest 132 [Suppl 3]:23–28

  7. Damhuis RA, Schutte PR (1996) Resection rates and postoperative mortality in 7,899 patients with lung cancer. Eur Respir J 9(1):7–10

    Article  CAS  PubMed  Google Scholar 

  8. Society for Cardiothoracic Surgery in Great Britain and Ireland (2007) Audits and comments. scts.org/sections/audit/index.html. Cited 25 Oct 2007

  9. Schulz C, Emslander HP, Riedel M (1999) Risk assessment of patients before lung surgery. Chirurg 70(6):664–673

    Article  CAS  PubMed  Google Scholar 

  10. Birim O, Zuydendorp HM, Maat AP et al (2003) Lung resection for non-small-cell lung cancer in patients older than 70: mortality, morbidity, and late survival compared with the general population. Ann Thorac Surg 76(6):1796–1801

    Article  PubMed  Google Scholar 

  11. Brock MV, Kim MP, Hooker CM et al (2004) Pulmonary resection in octogenarians with stage I non-small cell lung cancer: a 22-year experience. Ann Thorac Surg 77(1):271–277

    Article  PubMed  Google Scholar 

  12. Fukuse T, Satoda N, Hijiya K et al (2005) Importance of a comprehensive geriatric assessment in prediction of complications following thoracic surgery in elderly patients. Chest 127(3):886–891

    Article  PubMed  Google Scholar 

  13. Fleisher LA, Beckman JA, Brown KA et al (2007) ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation 116(17):1971–1996

    Article  PubMed  Google Scholar 

  14. Poldermans D, Bax JJ, Boersma E et al (2009) Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery: The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA). Eur Heart J 30(22):2769–2812

    Article  PubMed  Google Scholar 

  15. Mishra PK, Pandey R, Shackcloth MJ et al (2009) Cardiac comorbidity is not a risk factor for mortality and morbidity following surgery for primary non-small cell lung cancer. Eur J Cardiothorac Surg 35(3):439–443

    Article  PubMed  Google Scholar 

  16. Volpino P, Cangemi R, Fiori E et al (2007) Risk of mortality from cardiovascular and respiratory causes in patients with chronic obstructive pulmonary disease submitted to follow-up after lung resection for non-small cell lung cancer. J Cardiovasc Surg 48(3):375–383

    CAS  Google Scholar 

  17. Tisi GM (1979) Preoperative evaluation of pulmonary function. Validity, indications, and benefits. Am Rev Respir Dis 119(2):293–310

    CAS  PubMed  Google Scholar 

  18. German Society of Pneumology (1994) Recommendations for preoperative diagnosis of lung function. Pneumologie 48 [Suppl 1]:296–299

    Google Scholar 

  19. Brunelli A, Berrisford RG, Rocco G et al (2009) The European Thoracic Database project: composite performance score to measure quality of care after major lung resection. Eur J Cardiothorac Surg 35(5):769–774

    Article  PubMed  Google Scholar 

  20. Quanjer PH, Tammeling GJ, Cotes JE et al (1993) Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J Suppl 16:5–40

    CAS  PubMed  Google Scholar 

  21. Brunelli A, Refai MA, Salati M et al (2006) Carbon monoxide lung diffusion capacity improves risk stratification in patients without airflow limitation: evidence for systematic measurement before lung resection. Eur J Cardiothorac Surg 29(4):567–570

    Article  PubMed  Google Scholar 

  22. Matsubara Y, Takeda S, Mashimo T (2005) Risk stratification for lung cancer surgery: impact of induction therapy and extended resection. Chest 128(5):3519–3525

    Article  PubMed  Google Scholar 

  23. Berrisford R, Brunelli A, Rocco G et al (2005) The European Thoracic Surgery Database project: modelling the risk of in-hospital death following lung resection. Eur J Cardiothorac Surg 28(2):306–311

    Article  PubMed  Google Scholar 

  24. Kearney DJ, Lee TH, Reilly JJ et al (1994) Assessment of operative risk in patients undergoing lung resection. Importance of predicted pulmonary function. Chest 105(3):753–759

    Article  CAS  PubMed  Google Scholar 

  25. Wu MT, Chang JM, Chiang AA et al (1994) Use of quantitative CT to predict postoperative lung function in patients with lung cancer. Radiology 191(1):257–262

    CAS  PubMed  Google Scholar 

  26. Kristersson S, Lindell SE, Svanberg L (1972) Prediction of pulmonary function loss due to pneumonectomy using 133 Xe-radiospirometry. Chest 62(6):694–698

    Article  CAS  PubMed  Google Scholar 

  27. Olsen GN, Block AJ, Tobias JA (1974) Prediction of postpneumonectomy pulmonary function using quantitative macroaggregate lung scanning. Chest 66(1):13–16

    Article  CAS  PubMed  Google Scholar 

  28. Bolliger CT, Guckel C, Engel H et al (2002) Prediction of functional reserves after lung resection: comparison between quantitative computed tomography, scintigraphy, and anatomy. Respiration 69(6):482–489

    Article  PubMed  Google Scholar 

  29. Ferguson MK, Vigneswaran WT (2008) Diffusing capacity predicts morbidity after lung resection in patients without obstructive lung disease. Ann Thorac Surg 85(4):1158–1164; discussion 1164–1165

    Article  PubMed  Google Scholar 

  30. Ferguson MK, Lehman AG, Bolliger CT et al (2008) The role of diffusing capacity and exercise tests. Thorac Surg Clin 18(1):9–17, v

    Article  PubMed  Google Scholar 

  31. Singh SJ, Morgan MD, Hardman AE et al (1994) Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation. Eur Respir J 7(11):2016–2020

    CAS  PubMed  Google Scholar 

  32. Pollock M, Roa J, Benditt J et al (1993) Estimation of ventilatory reserve by stair climbing. A study in patients with chronic airflow obstruction. Chest 104(5):1378–1383

    Article  CAS  PubMed  Google Scholar 

  33. Brunelli A, Al Refai M, Monteverde M et al (2002) Stair climbing test predicts cardiopulmonary complications after lung resection. Chest 121(4):1106–1110

    Article  PubMed  Google Scholar 

  34. Loewen GM, Watson D, Kohman L et al (2007) Preoperative exercise Vo2 measurement for lung resection candidates: results of Cancer and Leukemia Group B Protocol 9238. J Thorac Oncol 2(7):619–625

    Article  PubMed  Google Scholar 

  35. Win T, Jackson A, Sharples L et al (2005) Cardiopulmonary exercise tests and lung cancer surgical outcome. Chest 127(4):1159–1165

    Article  PubMed  Google Scholar 

  36. Benzo R, Kelley GA, Recchi L et al (2007) Complications of lung resection and exercise capacity: a meta-analysis. Respir Med 101(8):1790–1797

    Article  PubMed  Google Scholar 

  37. Pierce RJ, Copland JM, Sharpe K et al (1994) Preoperative risk evaluation for lung cancer resection: predicted postoperative product as a predictor of surgical mortality. Am J Respir Crit Care Med 150(4):947–955

    CAS  PubMed  Google Scholar 

  38. Ribas J, Diaz O, Barbera JA et al (1998) Invasive exercise testing in the evaluation of patients at high-risk for lung resection. Eur Respir J 12(6):1429–1435

    Article  CAS  PubMed  Google Scholar 

  39. Miyoshi S, Yoshimasu T, Hirai T et al (2000) Exercise capacity of thoracotomy patients in the early postoperative period. Chest 118(2):384–390

    Article  CAS  PubMed  Google Scholar 

  40. Varela G, Brunelli A, Rocco G et al (2006) Predicted versus observed FEV1 in the immediate postoperative period after pulmonary lobectomy. Eur J Cardiothorac Surg 30(4):644–648

    Article  PubMed  Google Scholar 

  41. Brunelli A, Varela G, Rocco G et al (2007) A model to predict the immediate postoperative FEV1 following major lung resections. Eur J Cardiothorac Surg 32(5):783–786

    Article  PubMed  Google Scholar 

  42. Edrich T, Sadovnikoff N (2010) Anesthesia for patients with severe chronic obstructive pulmonary disease. Curr Opin Anaesthesiol 23(1):18–24

    Article  PubMed  Google Scholar 

  43. Qaseem A, Snow V, Fitterman N et al (2006) Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med 144(8):575–580

    PubMed  Google Scholar 

  44. Lawrence VA, Dhanda R, Hilsenbeck SG et al (1996) Risk of pulmonary complications after elective abdominal surgery. Chest 110(3):744–750

    Article  CAS  PubMed  Google Scholar 

  45. Boldt J, Piper S, Uphus D et al (1999) Preoperative microbiologic screening and antibiotic prophylaxis in pulmonary resection operations. Ann Thorac Surg 68(1):208–211

    Article  CAS  PubMed  Google Scholar 

  46. Schussler O, Alifano M, Dermine H et al (2006) Postoperative pneumonia after major lung resection. Am J Respir Crit Care Med 173(10):1161–1169

    Article  PubMed  Google Scholar 

  47. Schussler O, Dermine H, Alifano M et al (2008) Should we change antibiotic prophylaxis for lung surgery? Postoperative pneumonia is the critical issue. Ann Thorac Surg 86(6):1727–1733

    Article  PubMed  Google Scholar 

  48. Nakagawa M, Tanaka H, Tsukuma H et al (2001) Relationship between the duration of the preoperative smoke-free period and the incidence of postoperative pulmonary complications after pulmonary surgery. Chest 120(3):705–710

    Article  CAS  PubMed  Google Scholar 

  49. Warner DO (2005) Preoperative smoking cessation: the role of the primary care provider. Mayo Clin Proc 80(2):252–258

    Article  PubMed  Google Scholar 

  50. Warner DO, Sarr MG, Offord KP et al (2004) Anesthesiologists, general surgeons, and tobacco interventions in the perioperative period. Anesth Analg 99(6):1766–1773, table of contents

    Article  PubMed  Google Scholar 

  51. Warner MA, Offord KP, Warner ME et al (1989) Role of preoperative cessation of smoking and other factors in postoperative pulmonary complications: a blinded prospective study of coronary artery bypass patients. Mayo Clin Proc 64(6):609–616

    CAS  PubMed  Google Scholar 

  52. Hofer S, Plachky J, Fantl R et al (2006) Postoperative pulmonale Komplikationen: Prophylaxe nach nichtkardiochirurgischen Eingriffen. Anaesthesist 55(4):473–484

    Article  CAS  PubMed  Google Scholar 

  53. Konietzko N (1992) Assessment of the preoperative risk of existing lung diseases. Internist (Berl) 33(6):379–386

  54. Konietzko N, Petro W, Brockmann M et al (1986) Bronchialkarzinom und pulmonale Hypertonie. Bedeutung für die Lungenresektion. Dtsch Med Wochenschr 111(48):1830–1833

    Article  CAS  PubMed  Google Scholar 

  55. Ross AF, Ueda K (2010) Pulmonary hypertension in thoracic surgical patients. Curr Opin Anaesthesiol 23(1):25–33

    Article  PubMed  Google Scholar 

  56. Ammash NM, Connolly HM, Abel MD et al (1999) Noncardiac surgery in Eisenmenger syndrome. J Am Coll Cardiol 33(1):222–227

    Article  CAS  PubMed  Google Scholar 

  57. Lai HC, Lai HC, Wang KY et al (2007) Severe pulmonary hypertension complicates postoperative outcome of non-cardiac surgery. Br J Anaesth 99(2):184–190

    Article  PubMed  Google Scholar 

  58. Ramakrishna G, Sprung J, Ravi BS et al (2005) Impact of pulmonary hypertension on the outcomes of noncardiac surgery: predictors of perioperative morbidity and mortality. J Am Coll Cardiol 45(10):1691–1699

    Article  PubMed  Google Scholar 

  59. Kreider ME, Hansen-Flaschen J, Ahmad NN et al (2007) Complications of video-assisted thoracoscopic lung biopsy in patients with interstitial lung disease. Ann Thorac Surg 83(3):1140–1144

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Anaesthesiologie, Klinikum der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität München (LMU), München, Deutschland

    H. Mutlak, S. Czerner, B. Zwissler & P. Lackermeier

  2. Chirurgische Klinik und Poliklinik, Klinikum der Universität München, Campus Großhadern, Ludwig-Maximilians-Universität München (LMU), München, Deutschland

    H. Winter

  3. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der J.W. Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    H. Mutlak

Authors
  1. H. Mutlak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Czerner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Winter
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Zwissler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Lackermeier
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Mutlak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mutlak, H., Czerner, S., Winter, H. et al. Präoperative Evaluation und Risikoeinschätzung in der Thoraxchirurgie. Anaesthesist 59, 918–928 (2010). https://doi.org/10.1007/s00101-010-1765-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-010-1765-z

Schlüsselwörter

Keywords

Search

Navigation