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Study objectives: To assess (1) the possibility of predicting long-term postoperative lung function, and (2) the usefulness of maximal oxygen consumption (VO[sub 2]max) as a criterion for operability and as a predictor of long-term disability. Design: Prospective study. Setting: Outpatients and inpatients of a university hospital. Participants: Sixty-two consecutive patients (mean ± SD age, 62 ± 8 years; 51 male and 11 female patients) were preoperatively evaluated for lung cancer resection (pneumonectomy or bilobectomy [n = 14] and lobectomy [n = 48]). Measurements: Clinical examination and recorded respiratory symptoms and spirometry results before surgery and 6 months after surgery. If predicted postoperative FEV[sub 1] (ppoFEV[sub 1]) was < 40%, patients underwent exercise testing; if VO[sub 2]max was between 10 mL/kg/min and 20 mL/kg/min, patients underwent a split-function study. Results: All the patients with ppoFEV[sub 1] &Ge; 40%—even those patients (26%) with FEV[sub 1] < 80%— underwent thoracotomy without further tests. Seven patients with ppoFEV[sub 1] < 40% underwent exercise testing, and three of them underwent a split-function study. Nine patients (15%; including six patients with COPD and one patient with asthma) had immediate postoperative complications (pneumonia [n = 5] and respiratory failure [n = 4]); seven of these patients had ppoFEV[sub 1] ≥ 40%. ppoFEV[sub 1] significantly underestimated the actual postoperative FEV[sub 1] (poFEV[sub 1]; p < 0.001) 6 months after pneumonectomy or bilobectomy but was reliable for actual poFEV[sub 1] after lobectomy. Two patients with predicted postoperative VO[sub 2]max > 10 mL/kg/min became oxygen dependent and had marked limitation of daily living. Conclusions: ppoFEV[sub 1] ≥ 40% reliably identifies patients not requiting further tests and not at long-term risk of respiratory disability. VO[sub 2]max, effective for defining the immediate surgical risk, is not useful in... [ABSTRACT FROM AUTHOR]