Routine pre- and post-neoadjuvant chemotherapy fitness testing is not indicated for oesophagogastric cancer surgery.

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

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.