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

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Tseng, Watson Hua-Sheng; Department of Medical Education, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
Chiu, Chien-Hung; Chang, Sing-Ya; Yang, Lan-Yan ;et al;

Annals of surgical oncology,2025 Oct 10

  • Background: Cardiopulmonary exercise testing (CPET) parameters, such as ventilatory equivalent for carbon dioxide (V̇ E /V̇CO 2 ), peak oxygen consumption (V̇O 2peak ), 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. V̇O 2peak 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). V̇ E /V̇CO 2 demonstrated no meaningful relationship with major complications. In addition, the present study found neither V̇O 2peak nor AT was associated with 1-year mortality after esophagectomy.
  • Conclusions: V̇O 2peak and AT were inversely associated with morbidity after esophagectomy, while V̇ E /V̇CO 2 offered limited prognostic value and none predict 1-year survival. V̇O 2peak is a key predictor of major and cardiopulmonary complications after esophagectomy and warrants further investigation, either alone or as part of a composite model.