Anest. intenziv. Med. 2025;36(4):280-286 | DOI: 10.36290/aim.2025.041

Risk­‑assesment before lung surgery - what's new? Narrative review articleReview Article

Bartoš Š.1,2 *, Predáč A.1,2 *, Čundrle I.1, 2
* Oba autoři se na finální verzi rukopisu podíleli ve stejné míře
1 Anesteziologicko­‑resuscitační klinika, Fakultní nemocnice u sv. Anny, Brno
2 Lékařská fakulta, Masarykova univerzita, Brno

Surgical treatment is the primary therapeutic option for patients with early-stage lung cancer. The most common causes of perioperative morbidity and mortality in these patients are postoperative pulmonary complications. Peak oxygen consumption (VO2) has long been considered the gold standard for predicting these complications. In recent years, several new parameters for risk assessment have been described in peer-reviewed journals, notably ventilatory efficiency (VE/VCO2 slope) and end-tidal CO2. Both parameters have demonstrated excellent predictive ability for postoperative pulmonary complications, even in patients in whom peak VO2 failed. This article provides an overview of current recommendations, with a focus on the latest findings in risk assessment for lung surgery.

Keywords: thoracic surgery, postoperative pulmonary complications, spiroergometry, ventilatory efficiency.

Received: May 15, 2025; Revised: August 20, 2025; Accepted: September 9, 2025; Prepublished online: October 31, 2025; Published: December 10, 2025  Show citation

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Bartoš Š, Predáč A, Čundrle I. Risk­‑assesment before lung surgery - what's new? Narrative review article. Anest. intenziv. Med. 2025;36(4):280-286. doi: 10.36290/aim.2025.041.
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    References

    1. ČR Ú. Prevenceproplice.cz. Prevenceproplice.cz. https://www.prevenceproplice.cz/. Accessed 15 Jan 2025.
    2. Agostini P, Cieslik H, Rathinam S, Bishay E, Kalkat MS, Rajesh PB, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax. 2010;65:815-8. Go to original source...
    3. Brat K, Tothova Z, Merta Z, Taskova A, Homolka P, Vasakova M, et al. Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in Patients Undergoing Thoracic Surgical Procedures. Ann Thorac Surg. 2016;102:1725-30. Go to original source...
    4. Steéphan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelly B, et al. Pulmonary Complications Following Lung Resection: A Comprehensive Analysis of Incidence and Possible Risk Factors. CHEST. 2000;118:1263-70. Go to original source...
    5. Baser S, Shannon VR, Eapen GA, Jimenez CA, Onn A, Keus L, et al. Pulmonary Dysfunction as a Major Cause of Inoperability Among Patients with Non-Small-Cell Lung Cancer. Clin Lung Cancer. 2006;7:344-9. Go to original source...
    6. Mazur A, Brat K, Homolka P, Merta Z, Svoboda M, Bratova M, et al. Ventilatory efficiency is superior to peak oxygen uptake for prediction of lung resection cardiovascular complications. PLOS ONE. 2022;17:e0272984. Go to original source...
    7. Brunelli A, Ferguson MK, Salati M, Vigneswaran WT, Jimenez MF, Varela G. Thoracic Revised Cardiac Risk Index Is Associated With Prognosis After Resection for Stage I Lung Cancer. Ann Thorac Surg. 2015;100:195-200. Go to original source...
    8. Brunelli A, Charloux A, Bolliger CT, Rocco G, Sculier J-P, Varela G, et al. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy). Eur Respir J. 2009;34:17-41. Go to original source...
    9. Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery: Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST. 2013;143:e166S-e190S. Go to original source...
    10. Holden DA, Rice TW, Stelmach K, Meeker DP. Exercise Testing, 6-Min Walk, and Stair Climb in the Evaluation of Patients at High Risk for Pulmonary Resection. CHEST. 1992;102:1774-9. Go to original source...
    11. Wahi R, McMurtrey MJ, DeCaro LF, Mountain CF, Ali MK, Smith TL, et al. Determinants of perioperative morbidity and mortality after pneumonectomy. Ann Thorac Surg. 1989;48:33-7. Go to original source...
    12. Nakahara K, Ohno K, Hashimoto J, Miyoshi S, Maeda H, Matsumura A, et al. Prediction of Postoperative Respiratory Failure in Patients Undergoing Lung Resection for Lung Cancer. Ann Thorac Surg. 1988;46:549-52. Go to original source...
    13. Cundrle I, Merta Z, Bratova M, Homolka P, Mitas L, Sramek V, et al. The risk of post-operative pulmonary complications in lung resection candidates with normal forced expiratory volume in 1 s and diffusing capacity of the lung for carbon monoxide: a prospective multicentre study. ERJ Open Res. 2023;9:00421-2022. Go to original source...
    14. Ferguson MK, Little L, Rizzo L, Popovich KJ, Glonek GF, Leff A, et al. Diffusing capacity predicts morbidity and mortality after pulmonary resection. J Thorac Cardiovasc Surg. 1988;96:894-900. Go to original source...
    15. Brunelli A, Refai MA, Salati M, Sabbatini A, Morgan-Hughes NJ, Rocco G. Carbon monoxide lung diffusion capacity improves risk stratification in patients without airflow limitation: evidence for systematic measurement before lung resection. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2006;29:567-70. Go to original source...
    16. Brunelli A, Xiumé F, Refai M, Salati M, Di Nunzio L, Pompili C, et al. Peak oxygen consumption measured during the stair-climbing test in lung resection candidates. Respir Int Rev Thorac Dis. 2010;80:207-11. Go to original source...
    17. Glaab T, Taube C. Practical guide to cardiopulmonary exercise testing in adults. Respir Res. 2022;23:9. Go to original source...
    18. Brat K, Homolka P, Merta Z, Chobola M, Heroutova M, Bratova M, et al. Prediction of Postoperative Complications: Ventilatory Efficiency and Rest End-tidal Carbon Dioxide. Ann Thorac Surg. 2023;115:1305-11. Go to original source...
    19. Brunelli A, Belardinelli R, Pompili C, Xiumé F, Refai M, Salati M, et al. Minute ventilation-to-carbon dioxide output (VE/VCO2) slope is the strongest predictor of respiratory complications and death after pulmonary resection. Ann Thorac Surg. 2012;93:1802-6. Go to original source...
    20. Shafiek H, Valera JL, Togores B, Torrecilla JA, Sauleda J, Cosío BG. Risk of postoperative complications in chronic obstructive lung diseases patients considered fit for lung cancer surgery: beyond oxygen consumption. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2016;50:772-9. Go to original source...
    21. Gitt AK, Wasserman K, Kilkowski C, Kleemann T, Kilkowski A, Bangert M, et al. Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death. Circulation. 2002;106:3079-84. Go to original source...
    22. Chase PJ, Kenjale A, Cahalin LP, Arena R, Davis PG, Myers J, et al. Effects of respiratory exchange ratio on the prognostic value of peak oxygen consumption and ventilatory efficiency in patients with systolic heart failure. JACC Heart Fail. 2013;1:427-32. Go to original source...
    23. Phillips DB, Collins SÉ, Stickland MK. Measurement and Interpretation of Exercise Ventilatory Efficiency. Front Physiol. 2020;11:659. Go to original source...
    24. Woods PR, Olson TP, Frantz RP, Johnson BD. Causes of Breathing Inefficiency During Exercise in Heart Failure. J Card Fail. 2010;16:835-42. Go to original source...
    25. Schwaiblmair M, Faul C, von Scheidt W, Berghaus TM. Ventilatory efficiency testing as prognostic value in patients with pulmonary hypertension. BMC Pulm Med. 2012;12:23. Go to original source...
    26. Torchio R, Guglielmo M, Giardino R, Ardissone F, Ciacco C, Gulotta C, et al. Exercise ventilatory inefficiency and mortality in patients with chronic obstructive pulmonary disease undergoing surgery for non-small-cell lung cancer. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2010;38:14-9. Go to original source...
    27. Bartos S, Svoboda M, Brat K, Lukes M, Predac A, Homolka P, et al. Causes of ventilatory inefficiency in lung resection candidates. ERJ Open Res. 2024. https://doi.org/10.1183/23120541.00792-2024. Go to original source... Go to PubMed...
    28. Svoboda M, Cundrle I, Plutinsky M, Homolka P, Mitas L, Chovanec Z, et al. New models for prediction of postoperative pulmonary complications in lung resection candidates. ERJ Open Res. 2024;10:00978-2023. Go to original source...
    29. Doporučený postup pro předoperační funkční vyšetření před plicním resekčním výkonem. Česká pneumologie - plicní lékařství. In: www.plicnilekarstvi.cz [internet]. Available from: https://www.plicnilekarstvi.cz/novinka/2308/doporuceny-postup-pro-predoperacni-funkcni-vysetreni-pred-plicnim-resekcnim-vykonem/. Accessed 16 Jan 2025.
    30. Dean HF, Carter F, Francis NK. Modern perioperative medicine - past, present, and future. Innov Surg Sci. 2019;4:123-31. Go to original source...
    31. Sekine Y, Chiyo M, Iwata T, Yasufuku K, Furukawa S, Amada Y, et al. Perioperative rehabilitation and physiotherapy for lung cancer patients with chronic obstructive pulmonary disease. Jpn J Thorac Cardiovasc Surg Off Publ Jpn Assoc Thorac Surg Nihon Kyobu Geka Gakkai Zasshi. 2005;53:237-43. Go to original source...
    32. Benzo R, Wigle D, Novotny P, Wetzstein M, Nichols F, Shen RK, et al. Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies. Lung Cancer Amst Neth. 2011;74:441-5. Go to original source...
    33. Gao K, Yu P-M, Su J-H, He C-Q, Liu L-X, Zhou Y-B, et al. Cardiopulmonary exercise testing screening and pre-operative pulmonary rehabilitation reduce postoperative complications and improve fast-track recovery after lung cancer surgery: A study for 342 cases. Thorac Cancer. 2015;6:443-9. Go to original source...
    34. Boujibar F, Bonnevie T, Debeaumont D, Bubenheim M, Cuvellier A, Peillon C, et al. Impact of prehabilitation on morbidity and mortality after pulmonary lobectomy by minimally invasive surgery: a cohort study. J Thorac Dis. 2018;10:2240-8. Go to original source...
    35. Licker M, Karenovics W, Diaper J, Frésard I, Triponez F, Ellenberger C, et al. Short-Term Preoperative High-Intensity Interval Training in Patients Awaiting Lung Cancer Surgery: A Randomized Controlled Trial. J Thorac Oncol Off Publ Int Assoc Study Lung Cancer. 2017;12:323-33. Go to original source...
    36. Brat K, Sova M, Homolka P, Plutinsky M, Genzor S, Pokorna A, et al. Multimodal prehabilitation before lung resection surgery: a multicentre randomised controlled trial. Br J Anaesth. 2025. https://doi.org/10.1016/j.bja.2025.03.018. Go to original source... Go to PubMed...

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