L'évaluation fonctionnelle avant traitement du cancer bronchique

Recently, four societies have published updated recommendations on the pre-therapeutic assessment of lung cancer patients (ACCP, ERS/ESTS, BTS). A cardiological evaluation has been included in all guidelines, based on clinical data and ECG. The first step of the respiratory assessment includes the forced expiratory volume in one second (FEV1) and the diffusing capacity of the lung for carbon monoxide (DLCO). DLCO is a strong predictor of postoperative mortality and morbidity after lung resection. Cardiopulmonary exercise test appeared as a very strong predictor of post-operative complications as well as a good predictor of long-term post-operative exercise capacity and is recommended in all patients with a decreased FEV1 or DLCO in one algorithm (ERS/ESTS). If exercise capacity is reduced, the predicted post-operative values (ppo) for FEV1 and DLCO are calculated. Before pneumonectomy, the contribution of the lung to be resected, needed to calculate ppo values, can be evaluated using scintigraphy or quantitative CT scan. On the other hand, in other guidelines, exercise tests are required only in patients with low ppo FEV1 or DLCO (ACCP, BTS). Besides a careful cardio-respiratory selection of patients, identification of comorbidities, smoking cessation, chest physiotherapy, and exercise training likely contribute to decrease post-operative complications. Finally, if algorithms could be established to select patients for major lung resection, only few recommendations could be elaborated to assess fitness for parenchymal sparing resections or radiotherapy.