Predictive Value of Preoperative Cardiopulmonary Exercise Testing for Complications and Mortality After Esophagectomy: A Meta-analysis.

Abstracts No Comments

Tseng WH; Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Chiu CH; Chang SY; Yang LY; Huang SC

Annals of Surgical Oncology. 33(2):889-904, 2026 Feb.

BACKGROUND: Cardiopulmonary exercise testing (CPET) parameters, such as
ventilatory equivalent for carbon dioxide (VE/VCO2), peak oxygen
consumption (VO2peak), and anaerobic threshold (AT), have been proposed as
potential predictors of postoperative complications. Yet, few systematic
analyses have examined the association between CPET variables and major
complications after esophagectomy, as defined by the Clavien-Dindo
classification. Associations with cardiopulmonary complications and
mortality also require updating on the basis of trial sequential analysis
(TSA).

MATERIALS AND METHODS: Systematic searches were conducted to identify
relevant studies reporting preoperative CPET values and major
complications, cardiopulmonary complications, and 1-year mortality.
Standardized mean differences (SMD, random-effects model) were calculated
and TSA was conducted to evaluate the robustness of evidence in the
previous and current meta-analyses.

RESULTS: A total of 12 studies met inclusion criteria. VO2peak was
correlated with major complications (SMD = – 0.42; 95% CI – 0.70 to –
0.14, p = 0.0032) and cardiopulmonary complications (SMD = – 0.39; 95% CI
– 0.65 to – 0.13, p = 0.0032). AT showed similar but weaker associations
with both outcomes (SMD = – 0.33 and – 0.22; 95% CI – 0.63 to – 0.03 and
CI – 0.40 to – 0.04, p = 0.033 and 0.018, respectively). VE/VCO2
demonstrated no meaningful relationship with major complications. In
addition, the present study found neither VO2peak nor AT was associated
with 1-year mortality after esophagectomy.

CONCLUSIONS: VO2peak and AT were inversely associated with morbidity
after esophagectomy, while VE/VCO2 offered limited prognostic value and
none predict 1-year survival. VO2peak is a key predictor of major and
cardiopulmonary complications after esophagectomy and warrants further
investigation, either alone or as part of a composite model.