Medical Oncologist
CION Cancer Clinics
Lung function tests before lung surgery | CION Cancer Clinics
A lobectomy removes part of a working lung, so the surgeon must know how much you can spare. Breathing tests measure what your lungs do now, and from that the team predicts what they will do after the operation. This page explains the tests, the words on the report, and what happens when the numbers are borderline. It cannot tell you whether your own result is enough. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- Why do I need breathing tests before a lobectomy?
- Which tests will I actually have?
- What happens at the breathing test appointment?
- The words on the report, in plain language
- Four things families tell us, and what is actually true
- What if my numbers are borderline?
- Common questions about breathing tests before lung surgery
The short answer
Why do I need breathing tests before a lobectomy?
Because a lobectomy removes part of a working lung, and the surgeon needs to know how much you can spare. Breathing tests measure what your lungs do now, and from that the team predicts what they will do after the operation. That prediction is what decides whether the operation is safe for you.
Two numbers matter most
The first is how much air you can blow out in one hard second, written on your report as FEV1. The second is how well oxygen crosses from your lungs into your blood, written as DLCO or gas transfer. Both are given as a percentage of what is expected for your age, height and sex. The surgeon works out what each would be after the lobe is gone.
What the result changes
A comfortable result usually means the planned operation goes ahead. A borderline result leads to more tests, to a smaller operation, or to a period of preparation before the date is fixed. A poor result may mean the team suggests radiotherapy instead. The tests are not an exam. They are how the team chooses the safest route for you.
If you have never been told you have a lung condition, the tests can still find one. Long-term smokers are often surprised by the result.What is measured
Which tests will I actually have?
Most people have the first two. The others are added when the first two leave a question open.
Spirometry
You blow as hard and as long as you can into a tube attached to a machine. It measures the size of your lungs and how fast you can empty them. It is often repeated after an inhaler to see whether your airways open up.
Gas transfer (DLCO)
You breathe in a harmless gas mixture, hold it briefly and breathe out. The machine measures how much crossed into your blood. It shows how well the lung tissue itself works, which spirometry cannot tell.
This is the number most often low in people who have smoked for many years.Exercise testing
If the first two are borderline, the team looks at how your heart and lungs cope together under effort. This may be a stair climb, a timed walk, or a test on an exercise bike wearing a mask that measures the oxygen you use.
Usually added when
- FEV1 or DLCO is lower than hoped
- You have known heart disease
- A larger operation is being considered
A lung perfusion scan
A scan that shows how much of your breathing each part of the lung actually does. If the lobe with the tumour is already doing very little, removing it costs you less than the plain numbers suggest.
Not sure whether this applies to you?
Ask an oncologistOn the day
What happens at the breathing test appointment?
Before you come
You will be told whether to use your usual inhalers that morning. Do not change them on your own. Avoid a heavy meal shortly before and wear loose clothing. Do not smoke on the day; it changes the reading. Bring your inhalers and your previous reports.
The blowing test
You sit, a soft clip goes on your nose, and you seal your lips around a mouthpiece. The technician coaches you to take the deepest breath you can and blow out as hard and as long as possible. It feels odd and you may cough.
The gas transfer test
You breathe in from the machine, hold your breath for a count of several seconds and breathe out slowly. The gas is harmless. This is repeated once or twice. Some people feel briefly light-headed and are given a moment to rest.
The result
A printed sheet with your numbers and the expected values beside them. The technician will not interpret it for you. The surgeon reads it alongside your scans and tells you what it means for the planned operation, usually at your next visit.
On your report
The words on the report, in plain language
- FEV1
- The amount of air you can blow out in the first hard second. A measure of how open your airways are.
- DLCO or TLCO
- Gas transfer. How well oxygen passes from the air sacs into the blood. Two names for the same test.
- Percent predicted
- Your number compared with what is expected for someone of your age, height and sex. This is the figure the surgeon looks at, not the raw number.
- ppo, or predicted postoperative
- The surgeon's estimate of your FEV1 or DLCO after the planned amount of lung is removed. This is the number the decision is really built on.
- VO2 max
- The most oxygen your body can use during hard exercise, measured on the bike test.
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Commonly believed
Four things families tell us, and what is actually true
"He failed the breathing test, so nothing can be done."
A low result closes one door and opens others. A smaller operation, preparation followed by a repeat test, or focused radiotherapy are all real options. A poor breathing test says the lungs are weak. It says nothing about whether the cancer can be treated.
"If I practise blowing at home I can pass it."
The test measures the size and health of your lungs, not your effort. A decision made on a false number puts you at risk. Blow your hardest on the day and let the number be what it is.
"It is too late to stop smoking now."
It is not. Stopping before surgery lowers the chance of chest infection and helps the lungs clear mucus afterwards, even when the operation is only weeks away. Your team can help you stop. This is the most useful thing you can do yourself.
"She walks to the temple every day, she does not need a test."
Being active is a good sign, and the surgeon will ask about it. It does not replace the measurement. Many people manage daily life on lungs that have quietly lost reserve, and it only shows when part of a lung is taken away.
Being straight with you
What if my numbers are borderline?
A borderline result means the team cannot yet say the operation is safe, and cannot yet say it is unsafe. It usually leads to an exercise test and a longer conversation, not to a quick no.
The options the team may put to you
A smaller operation, removing a segment or a wedge rather than the whole lobe, costs less lung. A few weeks of breathing exercises, walking and stopping smoking can lift the numbers enough to change the answer; the test is then repeated. Where the risk stays high, SBRT, a focused form of radiotherapy, is offered instead. Each has a trade-off.
Who this approach does not suit
Preparation and retesting take time. If the cancer is growing quickly, or if a lymph node is already involved, the team may not want to wait. Ask how much time you have, so that you are not preparing for an operation that is no longer the right one.
What this page cannot tell you
It cannot tell you whether your own numbers are good enough. The threshold moves with the planned operation and with your heart, kidneys and age. Only the surgeon who has your report and scans can answer that.
Ask for a copy of the breathing test report. You will want it if you seek a second opinion.Questions we are asked
Common questions about breathing tests before lung surgery
What FEV1 do I need for a lobectomy?
There is no single number. Surgeons look at the value predicted after the lobe is removed, and at gas transfer and exercise capacity alongside it. Someone with a modest FEV1 but a lobe that already does little work may be safer than the raw number suggests. Ask your surgeon for your predicted postoperative values.
Does the test hurt or make me breathless?
It does not hurt. Blowing out hard several times can leave you briefly winded, light-headed or coughing, and the technician will let you rest between attempts. If you have chest pain or become very breathless during the test, say so at once.
I have COPD. Can I still have the operation?
Often, yes. Many people with COPD have lung cancer operations safely, sometimes a smaller one than first planned. An exercise test and a perfusion scan tell the team how much reserve you truly have. Stopping smoking and getting your inhalers adjusted before surgery both help. The answer is individual.
Can the test be done at a local hospital in my district?
Spirometry is widely available. Gas transfer and exercise testing need special equipment and are usually done at the centre where the surgery is planned, so that the surgeon trusts the result. If you have a recent report from elsewhere, bring it.
How long do the results stay valid?
Usually until something changes. A chest infection, a change in inhalers, stopping smoking or a delay of several months can all shift the numbers, and the surgeon may ask for a repeat just before the operation. That is the team making sure the decision rests on today's lungs.
Will I need a heart test as well?
Everyone has a basic heart tracing, and many people have an echo, a scan of the heart's pumping. If you have had a heart attack, chest pain or a stent, a cardiologist may review you and add a stress test. The lungs and the heart share the load of an operation, so both are checked.
What if I cannot manage the exercise test?
Tell the team before it is booked. Painful knees, poor balance or a previous stroke can make a bike or stair test impossible, and there are other ways to estimate your reserve. Being unable to do the test is not the same as failing it.
Is the test covered by Aarogyasri or my insurance?
When it is part of an approved cancer surgery plan, it is usually covered. Aarogyasri, CGHS, ECHS and EHS are all accepted at CION, and most cashless insurers are empanelled. Call the helpline with your card or policy details and we will check what your cover includes before you travel.
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Sources
- NHS — Spirometry
- Cancer Research UK — Surgery for lung cancer
- NICE — Lung cancer: diagnosis and management (NG122)
- American Cancer Society — Surgery for Non-Small Cell Lung Cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Surgery for Lung Cancer With COPDWhat the tests mean when you already have a lung conditionSmoking Before and After Lung SurgeryThe one change that most improves your numbersSurgery or SBRT for Early Lung Cancer?The alternative when the operation is judged too riskyFitness, Tests and PrehabilitationGetting ready for any cancer operationBreathing Exercises After Lung SurgeryThe exercises you can start practising now
Talk to us
Have a breathing test report and not sure what it means?
Send it to us with your scans, or call the helpline. A surgical oncologist will read it with you and explain what it means for the operation being planned.