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Thoracic Portal Survey Results - Assessment of Operability for Early Stage Lung Cancer

Sunday, February 24, 2013


For purposes of this survey, participants were asked to evaluate a 65 year old man with a 50 pack-year smoking history that he quit 6 months prior to the consultation. He had a 2.5 cm adenocarcinoma near the hilum of the right upper lobe. The lesion was not amenable to wedge or segmental resection. There was no evidence on CT or PET of hilar or mediastinal nodal involvement. He had no history of cardiovascular disease, had no respiratory symptoms, and had no limitations in activity. You plan was to perform a right upper lobectomy.

The vast majority of respondents would get spirometry and about two-thirds of respondents would also routinely measure diffusing capacity (DLCO). Low tech exercise testing was used by a quarter of respondents, and routine high tech exercise testing was used rarely.

Indications for assessing DLCO in those participants who don’t do it routinely were mixed, but usually were related to low preoperative or estimated postoperative FEV1. A small number of participants don’t use DLCO to assess risk.

The use of low tech exercise testing was triggered most often by low postoperative predicted DLCO% or FEV1%. About 30% of participants don’t use stair climbing to evaluate patients. High tech exercise testing was indicated by low postoperative predicted DLCO% or FEV1%, or by impaired stair climbing ability. One-third of respondents don’t assess peak VO2 under any circumstances.

Regional lung function is assessed by nearly 85% of respondents under some circumstances, but there was little consensus on the indications. Low ppoDLCO% and ppoFEV1% were the most common indications, but heterogenous emphysema and lobar obstruction were also common indications.

This survey was completed by over 300 participants, which is the largest participation level we have seen for such surveys. This may indicate the general interest level in assessment of the high risk patient for lung resection.

1. What pulmonary function testing would you routinely perform for this patient (check all that apply)?
  AnsweredQuestion 308
  ResponsePercent ResponseCount
97.7% 301
Diffusing capacity
67.2% 207
Low tech exercise test (stair climbing)
24.4% 75
High tech exercise test (such as bicycle ergometry with measurement of peak VO2)
1.9% 6
I would not do any testing for this patient
1.6% 5
2. What indication would you use for measuring DLCO in this patient (check the single best answer)?
  AnsweredQuestion 306
  ResponsePercent ResponseCount
Low FEV1
10.5% 32
Low FEV1%
9.2% 28
Low ppoFEV1
2.0% 6
Low ppoFEV1%
7.2% 22
I would not measure DLCO for this patient
6.9% 21
I routinely measure DLCO
64.4% 197
3. What indication would you use for measuring stair climbing ability in this patient?
  AnsweredQuestion 305
  ResponsePercent ResponseCount
Low ppoFEV1%
8.5% 26
Low ppoDLCO%
4.3% 13
Either low ppoFEV1% or low ppoDLCO%
28.2% 86
None of the above
4.3% 13
I don’t assess stair climbing performance
29.8% 91
I routinely assess stair climbing performance
24.9% 76
4. What indication would you use for measuring peak VO2 in this patient?
  AnsweredQuestion 304
  ResponsePercent ResponseCount
Either low ppoFEV1% or low ppoDLCO%
43.8% 133
Impaired stair climbing ability
18.8% 57
I don’t assess peak VO2
34.5% 105
I routinely assess peak VO2
3.0% 9
5. When would you perform regional lung function assessment (such as quantitative V/Q scan or quantitative CT scan) for this patient (check all that apply)?
  AnsweredQuestion 303
  ResponsePercent ResponseCount
If either ppoFEV1% or ppoDLCO% is low
58.7% 178
if there is evidence for heterogenous emphysema
28.4% 86
if there is evidence for segmental or lobar bronchial obstruction
18.8% 57
I don’t assess regional lung function
17.2% 52
I routinely perform regional lung function assessment
3.6% 11
6. In what region do you practice?
  AnsweredQuestion 307
  ResponsePercent ResponseCount
North America
49.2% 151
28.7% 88
South America
4.9% 15
Middle East
2.3% 7
10.1% 31
3.6% 11
Australia/New Zealand
1.3% 4



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