Criteria for Medically Inoperable Patients

Medically inoperable patients are those who would not benefit from surgery because their underlying non cancer illness puts them at a  high risk of dying from the surgery itself.  The severity and type of underlying non-cancer illnesses have been variably described by different groups and linked to the likelihood of death within 30 days of treatment.  The criteria are designed to pick patients who are healthy enough to tolerate the stress of surgery itself.  One measure of the ability of a group of patients to tolerate surgery is the likelihood that they will be alive for the first month after surgery.  The vast majority of death within one month after surgery is felt to represent the complications of the treatment as opposed to the effects of the cancer.  This is discussed more in Dr. Rizwan Nurani's blog post.  These criteria assume that the planned surgery is a lobectomy or pneumonectomy.  If even a single major criterion is present a patient is not considered for surgery.

  MAJOR Criteria (1 needed):

       FEV1 < 50% or predicted postoperative FEV1 < 40%

       DLCO < 50% or predicted postoperative DLCO < 40%

       M VO2 (Exercise induced maximal exercise oxygen consumption) <15 ml/kg/min

       High-risk cardiac disease:

  • LVEF <20%
  • Unstable coronary syndrome
  • Severe valvular disease (critical valvular stenosis)
  • Significant arrhythmia


MINOR Criteria (2 needed):

  •             Age > 75
  •             FEV1 51%-60% or predicted postoperative FEV1 41-50%
  •             DLCO 51-60% or predicted postoperative DLCO 41-50%
  •             Pulmonary hypertension (Sys>40mm Hg)
  •             Room air O2 Sat <88%
  •             Resting or exercise arterial pO2 ≤ 55 mm Hg
  •             pCO2 > 45 mm Hg
  •             CHF
  •             LVEF 21-40%
  •             Recent CVA/TIA
  •             Diabetes Mellitus with severe end organ damage
  •             Modified Med Research Council Dyspnea Scale ≥ grade 3
© Rizwan Nurani 2012