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PROGNOSTIC VALUE OF CARDIOPULMONARY EXERCISE TESTING FOR MORBIDITY RISK AND SURVIVAL AFTER ESOPHAGECTOMY FOR CANCER
Neil Patel*, Andi Beamish, Chris Brown, Arfon G. Powell, Tarig Abdelrahman, Xavier Escofet, Guy Blackshaw, Tim Havard, Wyn G. Lewis
General Surgery, University Hospital Wales, Cardiff, Wales, United Kingdom
Background: The aim of this study was to assess the prognostic value of physical fitness variables determined objectively by means of cardiopulmonary exercise testing (CPET) in patients undergoing potentially curative esophagectomy for cancer.
Methods: Consecutive 193 patients diagnosed with oesophageal cancer (OC, 106 ACA, 11 SCC, 3HGD) underwent preoperative CPET with prospective recording of morbidity and survival. Non-parametric receiver operating characteristic (ROC) curves and logistic regression were used to assess the relationship between CPET variables and postoperative morbidity.
Results: Of 193 patients assessed, 120 were included for analysis; (median age 65 (38-84) yr, 100 males, 75 neoadjuvant therapy); 73 did not proceed to surgery and were excluded. Postoperative morbidity and mortality occurred in 83 (69%, CD>3 in 27, 22.5%) and 4 (3.3%) of patients respectively. ROC curve analysis showed oxygen uptake (peak Vo2) gave an area under the ROC of 0.680 (95% CI 0.57 to 0.79, p=0.004) with an optimum cut off value of 17.25 ml/kg/min giving a sensitivity of 70.5% and specificity of 51.7%. Anaerobic Threshold (AT) and minute ventilation (VE/VCO2) were not associated with postoperative morbidity (p=0.576 and p=0.232 respectively). Cumulative survival was significantly associated with operative morbidity severity score (p=0.028) but not with CPET variables.
Conclusion: CPET is a significant predictor of morbidity after esophageal cancer surgery with peak VO2 rather than AT proving to be the most important factor.
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