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Pre-operative lung cancer assessment — SCE Respiratory MCQ

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ModerateLung CancerPre-operative lung cancer assessmentSCE Respiratory

A 71-year-old man with stage I NSCLC is being assessed for lobectomy. FEV1 is 78% predicted but TLCO is 38% predicted. He climbs one flight of stairs slowly and desaturates to 87% on shuttle walk testing. What is the most appropriate management?

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Correct answer: C — Refer for formal cardiopulmonary exercise testing and thoracic surgical risk review

Low TLCO and exertional desaturation despite preserved FEV1 require further physiological risk assessment, often CPET, before lung resection. FEV1 alone is insufficient for operability decisions. Empirical chemoradiotherapy may be considered if surgery is unsuitable, but only after MDT and proper staging/risk review.

Reference: BTS Guidelines for Fitness for Radical Treatment of Lung Cancer; NICE NG122