Lam S; Alexandre L; Hardwick G; Hart AR.

Surgery. 166(1):28-33, 2019 07.

BACKGROUND: Postoperative complications after esophagectomy are thought to
be associated with reduced fitness. This observational study explored the
associations between aerobic fitness, as determined objectively by
preoperative cardiopulmonary exercise testing (CPEX), and 30-day morbidity
after esophagectomy.

METHODS: We retrospectively identified 254 consecutive patients who
underwent esophagectomy at a single academic teaching hospital between
September 2011 and March 2017. Postoperative complication data were
measured using the Esophageal Complications Consensus Group definitions
and graded using the Clavien-Dindo classification system of severity
(blinded to cardiopulmonary exercise testing values). Associations between
preoperative cardiopulmonary exercise testing variables and postoperative
outcomes were estimated using logistic regression.

RESULTS: A total of 206 patients (77% male) were included in the
analyses, with a mean age of 67 years (SD 9). The mean values for the
maximal oxygen consumed at the peak of exercise (VO2peak) and the
anaerobic threshold were 21.1 mL/kg/min (SD 4.5) and 12.4 mL/kg/min (SD
2.8), respectively. The vast majority of patients (98.5%) had malignant
disease-predominantly adenocarcinoma (84.5%), for which most received
neoadjuvant chemotherapy (79%) and underwent minimally invasive Ivor Lewis
esophagectomy (53%). Complications at postoperative day 30 occurred in 111
patients (54%), the majority of which were cardiopulmonary (72%). No
associations were found between preoperative cardiopulmonary exercise
testing variables and morbidity for either VO2peak (OR 1.00, 95% CI
0.94-1.07) or anaerobic threshold (OR 0.98, 95% CI 0.89-1.09).

CONCLUSION: Preoperative cardiopulmonary exercise testing variables were
not associated with 30-day complications after esophagectomy. The findings
do not support the use of cardiopulmonary exercise testing as an isolated
preoperative screening tool to predict short-term morbidity after
esophagectomy. This modestly sized observational work highlights the need
for larger studies examining associations between preoperative
cardiopulmonary exercise testing and outcomes after esophagectomy to look
for consistency in our findings.