Lung Resection Assessment — FRCA Final MCQ

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ModeratePreoperative AssessmentLung Resection AssessmentFRCA Final

A 70-year-old man with severe COPD is being assessed for right lower lobectomy for non-small-cell lung cancer. His predicted postoperative FEV1 is 28% predicted and his predicted postoperative TLCO is 35% predicted. Cardiac assessment has identified no unstable cardiovascular disease. Which additional investigation is most appropriate for further physiological risk stratification?

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Correct answer: B — Cardiopulmonary exercise testing

Cardiopulmonary exercise testing is the best further investigation. The ppoFEV1 is below 30% predicted, indicating markedly impaired postoperative respiratory reserve and a need for formal, integrated assessment of pulmonary, cardiovascular and peripheral oxygen utilisation. CPET measures peak oxygen uptake and ventilatory efficiency: a VO2peak below 10 mL kg−1 min−1 indicates very high operative risk, whereas a value above 20 mL kg−1 min−1 suggests low physiological risk; intermediate results require multidisciplinary interpretation. An incremental shuttle walk test is a useful lower-technology screening test, particularly for intermediate impairment or where CPET is unavailable, but is less definitive here. Peak flow does not quantify operative reserve. Arterial blood gases assess resting gas exchange rather than exercise capacity, and high-resolution CT provides anatomical information rather than integrated physiological risk.

Reference: Fukui M, et al. Exercise oxygen desaturation is a predictor of cardiopulmonary complications after lung resection. BMJ Open Respiratory Research. 2022;9:e001397. https://bmjopenrespres.bmj.com/content/9/1/e001397