Drummond RJ, Vass D, Wadhawan H, Craig CF, MacKay CK, Fullarton
GM, Forshaw MJ

Ann R Coll Surg Engl. 2018 Apr 25:1-5. doi: 10.1308/rcsann.2018.0067. [Epub ahead
of print

Introduction There is a known correlation between anaerobic threshold (AT) during
cardiopulmonary exercise testing and development of cardiopulmonary complications
in high-risk patients undergoing oesophagogastric cancer surgery. This study
aimed to assess the value of routine retesting following neoadjuvant
chemotherapy.

Methods Patients undergoing neoadjuvant chemotherapy with
subsequent oesophagogastric cancer surgery with pre- and post-neoadjuvant
chemotherapy cardiopulmonary exercise data were identified from a prospectively
maintained database. Measured cardiopulmonary exercise variables included AT and
maximum oxygen uptake at peak exercise (VO2 peak). Anaerobic threshold values
within 1 ml/kg/minute were considered static. Patients were grouped into AT
ranges of less than 9 ml/kg/minute, 9-11 ml/kg/minute and greater than 11
ml/kg/minute. Outcome measures were unplanned intensive care stay, postoperative
cardiovascular morbidity and mortality.

Results Between May 2008 and August 2017,
42 patients from 675 total resections were identified, with a mean age of 65
years (range 49-84 years). Mean pre-neoadjuvant chemotherapy AT was 11.07
ml/kg/minute (standard deviation, SD, 3.24 ml/kg/minute, range 4.6-19.3
ml/kg/minute) while post-neoadjuvant chemotherapy AT was 11.19 ml/kg/minute (SD
3.05 ml/kg/minute, range 5.2-18.1 ml/kg/minute). Mean pre-neoadjuvant
chemotherapy VO2 peak was 17.13 ml/kg/minute, while post-chemotherapy this mean
fell to 16.59 ml/kg/minute. Some 44.4% of patients with a pre-chemotherapy AT
less than 9 ml/kg/minute developed cardiorespiratory complications compared with
42.2% of those whose AT was greater than 9 ml/kg/minute (P = 0.914); 63.6% of
patients in the post-neoadjuvant chemotherapy group with an AT less than 9
ml/kg/minute developed cardiorespiratory complications. There was no correlation
between direction of change in AT and outcome.

Conclusion In our patient
population, neoadjuvant chemotherapy does not appear to result in a significant
mean reduction in cardiorespiratory fitness. Routine pre- and post-neoadjuvant
chemotherapy cardiopulmonary exercise testing is currently not indicated;
however, larger studies are required to demonstrate this conclusively.