According to a recent article published in the journal Chest, the diffusion capacity of the lung for carbon monoxide (DLCO) appears to be more accurate than currently used methods for predicting outcomes following surgery of the lung.

Presently, the surgical removal of lung cancer appears to be the only curative option. Chemotherapy, radiation and /or biologic therapy can also prolong survival, improve quality of life or shrink the cancer so that surgical removal is feasible in some patients. However, many patients do not tolerate surgery well and researchers have been investigating variables that may indicate how a patient will respond to the procedure.

The most common test used to determine if a patient with lung cancer is able to tolerate surgery is called forced expiratory volume in one second (FEV1). FEV1 is the measure of the volume of air that is exhaled in one second as forcefully as possible. Another test that is commonly used to help determine how a patient may tolerate surgery is the evaluation of a patient after a six-minute walk. Now, researchers believe that DLCO levels may also be an accurate predictor of how lung cancer patients may tolerate surgery. DLCO is a test that requires patients to inhale gas that contains a small, known quantity of carbon monoxide. Patients hold their breath for 10 seconds and then forcefully exhale. The exhaled gas is measured to determine how much carbon monoxide is absorbed by the lungs.

Researchers recently conducted a clinical trial to directly compare the predictive values of pre-operative FEV1, six-minute walk results and DLCO in determining how a lung cancer patient would tolerate surgery. The clinical trial involved 139 patients who filled out health surveys measuring quality of life preoperatively, during the hospital stay and six months following surgery. The only variable found to accurately predict the quality of life following surgery was a low DLCO. FEV1, six-minute walk results, preoperative or postoperative chemotherapy and/or radiation, extent of surgery and postoperative complications did not appear to accurately predict the postoperative quality of life of these patients.

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These researchers concluded that DLCO measurements more accurately predict surgical outcomes than FEV1 or six-minute walk results in lung cancer patients. Future studies evaluating the predictive value of DLCO in combination with other variables are warranted. Patients who are to undergo surgery for lung cancer may wish to speak with their physician about DLCO testing or participation in a clinical trial further evaluating other novel preoperative testing. Two sources of information regarding ongoing clinical trials include the National Cancer Institute ( and also provides personalized clinical trial searches on behalf of patients.

Reference: Handy J Jr, Asaph J, Skokan L, et al. What happens to patients undergoing lung cancer surgery?: outcomes and quality of life before and after surgery.

Chest. 2002;122:21-30.

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