Preoperative evaluation of the pacient with bronchopulmonary cancer

BACKGROUND.In the Republic of Moldova, we have reported 983 cases of bronchopulmonary cancer (BPC)annually, in 2019. This impressive number of patients requires a more efficient mobilization of the medicalsystem to solve these cases.AIM. The high incidence of newly diagnosed cases of BPC in advanced stages implies a reserved attitude forthe surgical treatment of these patients, as well as the presence of associated pathologies, compromise morethe situations, and the possibility to provide effective solutions to solve these cases. The group of patientswho have tertiary prevention as a measure of treatment becomes imposing. This order of ideas outlines theneed for a different medical-surgical approach for this category of patients. METHODS AND RESULTS.Forthe assessment of functional criteria for operability for patients with BPC, especially in advanced lung cancer,using comorbidity scores (ASA, Charlson, Elixhauser) and the formation of indications for surgical treatmentare significant, because surgery offers the greatest opportunity for healing. The team responsible for thepreoperative assessment should include both a perioperative mortality risk assessment and a postoperativepulmonary function prediction to optimally advise patients on anticipated outcomes. Due to both advancedcancer on presentation and comorbid conditions, only one-third of patients are ultimately consideredcandidates for surgical resection. Despite modern surgical, anesthetic, and postoperative techniques, there isstill a perioperative mortality rate of 1-5%. Postoperative myocardial infarction is an important source ofmorbidity and mortality for those undergoing extensive lung resections, especially trans-pericardialpneumonectomies. Until surgery is suggested, preoperative evaluation of the cardiovascular system shouldbe required for the existence of active heart disease (unstable angina, recent myocardial infarction,decompensated heart failure, arrhythmias, or valve defects).In addition to identifying cardiac risk factors, apreoperative assessment is incomplete without quantifying a patient's functional capacity. This can beachieved by the results of a formal stress test, measured in units of metabolic equivalents of task (MET).Geriatric assessment (GA) is a method used to collect information about the physical condition of elderlypatients, which may be useful in estimating life expectancy and predicting treatment toxicity. GA includes anassessment of functional status, fatigue, cognitive function, mental health, nutritional status, the individual'sability to complete instrumental activities of daily living, comorbidities, social support, and the presence ofgeriatric syndromes. CONCLUSIONS. A thorough analysis of the results of diagnostic tests, referring to thefunctional evaluation of patients with advanced BPC and/or comorbidities, would allow the extension ofsurgical indications to obtain new results and increase over time the survival and quality of life of thesepatients.