In the evaluation and preparation of a 55-year-old smoker for resection of a 3 cm pulmonary adenocarcinoma, the following is/are true:

b. Resting PaCO2 is of more value than PaO2

c. FEV1 is of more value than measured vital capacity

e. V/Q lung scan is useful when pulmonary reserve is marginal

Preoperative cessation of smoking for a period of 2 weeks can reduce pulmonary complications and should be required. In the preoperative assessment for pulmonary resection, the PaCO2 is of more value than the PaO2 since an elevated PaCO2 > 50 mmHg identifies the very high risk patient with chronic lung disease. Hypoxemia may be secondary to the mechanical effects of the tumor producing ventilation/perfusion mismatch. The latter can be confirmed by V/Q lung scan which also serves to identify areas of functioning lung in patients with marginal pulmonary function. The best screening test for adequacy of pulmonary reserve is the FEV1. It identifies obstructive pulmonary disease which is more important than the restrictive lung disease identified by vital capacity measurement. Diffusion capacity measurement provides little additional information of value.