RESUMEN

La valoración de los pacientes en quienes se proyecta realizar una resección pulmonar tiene como objetivo evitar el desarrollo de complicaciones posoperatorias. Debe incluir historia y exploración física completas, además de una espirometría con cálculo de volumen espiratorio forzado del primer segundo (VEF₁) posoperatorio predicho y de forma óptima la determinación de capacidad de difusión (DLCO), ambos deberán de ser mayores al 60% para considerarse como bajo riesgo. En los pacientes que no cumplen estos requisitos deberá de realizarse estudios de gammagrafía pulmonar para el cálculo del VEF₁ posoperatorio, así como pruebas de ejercicio y consumo de oxígeno. Existen múltiples abordajes propuestos para la valoración de estos pacientes, algunos serán analizados en el texto.

PALABRAS CLAVE

Espirometría, volumen espiratorio forzado del primer segundo (VEF₁), capacidad de difusión, gammagrama pulmonar ventilatorio/perfusorio (V/Q), consumo de oxígeno.

REFERENCIAS

1. Kearney DJ, Lee TH, Reilly, et al. Assessment of operative risk in patients undergoing lung resection: importance of predicted pulmonary function. Chest 1994; 105: 753-59.

2. Stephan F, Boucheseiche S, Hollande J, et al. Pulmonary complication following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest 2000; 118: 1263-1270.

3. Datta D, Lahiri B. Preoperative evaluation of patients going to lung resection surgery. Chest 2003; 123: 2096-2103.

4. Kristersson S, Lindell S, Strandberg L. Prediction of pulmonary function loss due to pneumonectomy using 133Xe radioisometry. Chest 1972; 62: 696-698.

5. Wernly JA, DeMeester TR, Kirchner PT, et al. Clinical value of quantitative ventilation-perfusion lung scans in the surgical management of bronchogenic carcinoma. Thorac Cardiovasc Surg 1980; 80: 535-543.

6. Markos J, Mullan BP, Hillman OR, et al. Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis 1989; 139: 902-916.

7. Van Nostrand D, Kjelsberg MD, Humphrey EW. Pre-resectional evaluation of risk from pneumonectomy. Surg Gynecol Obstet 1968; 127: 306-312.

8. Olsen GN, Bolton JWR, Weiman DS, et al. Stair climbing as an exercise test to predict the post-operative complications of lung resection. Chest 1991; 99: 587-590.

9. Wasserman K, Whipp BJ. Exercise physiology in health and disease. Am Rev Respir Dis 1975; 112: 219-259.

10. Holden DA, Rice TW, Stelmach K. Exercise testing, 6-minute walk and stair climbing in the evaluation of patients at high risk for pulmonary resection. Chest 1992; 102: 1774-1779.

11. Girish M, Trayner E, Dammann O, et al. Symptom-limited stair climbing as a predictor of postoperative cardiopulmonary complications after high-risk surgery. Chest 2001; 120: 1147-1151.

12. Smith TP, Kinasewitz GT, Tucker WY, et al. Exercise capacity as a predictor of post-thoracotomy morbidity. Am Rev Respir Dis 1984; 129: 730-734.

13. Bollinger CT, Jordan P, Soler M, et al. Exercise capacity as a predictor of postoperative complications in lung resection candidates. Am J Respir Crit Care Med 1995; 151: 1472-1480.

14. Bobbio A, Chetta A, Carbognani P, et al. Changes in pulmonary function test and cardiopulmonary exercise capacity in COPD patients after lobar pulmonary resection. Eur Journ Cardio Thorac Surg 2005; 28: 754-758.

15. Schuurmans M, Diacon A, Bolliger C. Functional evaluation before lung resection. Clin Chest Med 2002; 23: 159-172.

16. Bolliger C, Perruchoud A. Functional evaluation of the lung resection candidate. Eur Resp Jour 1998; 11: 198-212.

17. Bolliger C, Coenraad F, Koegelenberg N, Kendal R. Preoperative assessment for lung cancer surgery. Curr Opin Pulm Med 2005; 11: 301-306.

18. Ribas J, Jiménez M, Barberâ J. Gas exchange and pulmonary hemodynamics during lung resection in patients at increased risk. Relationship with preoperative exercise testing. Chest 2001; 120: 852-859.

19. Warner MA, Offord KP, Warner ME, et al. 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 1989; 64: 609-616.