Our current understanding of and approach to the management of lung cancer with pulmonary hypertension

ABSTRACT

Introduction

Lung cancer is a frequent pathology for which the best curative treatment is pulmonary resection. Pulmonary arterial hypertension is a rare disease but pulmonary hypertension associated with parenchymal disease or left heart disease is frequently observed in these patients. The diagnosis of pulmonary hypertension before lung resection makes the perioperative management of these patients more difficult and sometimes leads to rejecting patients for surgery.

Areas covered

We performed a review of literature on PubMed on Pulmonary hypertension associated lung resection, preoperative assessment of lung resection and perioperative management of PH patients, including guidelines and clinical trials.

In this review, we summarize the current state of knowledge regarding the pre and perioperative management of patients with suspected or confirmed PH who can benefit from surgical treatment of lung cancer.

Expert opinion

Management of PH patients before lung resection should include a very careful workup including at least right heart catheterization with evaluation of the targeted PH treatment in an expert center and evaluation of other comorbidities. Perioperative management must be carried out in a specialized center.

KEYWORDS:

• Lung cancer
• pneumonectomy
• right heart catheterization
• pulmonary arterial hypertension
• thoracic surgery
• exercise test

Article highlights

• Guidelines concerning physiological evaluation of lung resection candidates are fairly clear but none specifically concerns patients with pulmonary hypertension.

• A complete evaluation must be carried out in a PH expert center including a cardiac and pulmonary assessment. Two tests are particularly essential: right heart catheterization and cardiopulmonary exercise test (CPET).

• The reevaluation or the initiation of the targeted PH treatment should be discussed for every patient before surgery.

• When technically and oncologically possible, pulmonary parenchyma savings and minimally invasive thoracic surgery must be discuss on a case-by-case basis.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.