The association between cardiopulmonary exercise testing and postoperative outcomes in patients with lung cancer undergoing lung resection surgery: A systematic review and meta-analysis.

Arbee-Kalidas N;  University of the Witwatersrand, Johannesburg, South Africa
Moutlana HJ; Moodley Y; Kebalepile MM; Motshabi Chakane P

PLoS ONE [Electronic Resource]. 18(12):e0295430, 2023

BACKGROUND: Exercise capacity should be determined in all patients
undergoing lung resection for lung cancer surgery and cardiopulmonary
exercise testing (CPET) remains the gold standard. The purpose of this
study was to investigate associations between preoperative CPET and
postoperative outcomes in patients undergoing lung resection surgery for
lung cancer through a review of the existing literature.
METHODS: A search was conducted on PubMed, Scopus, Cochrane Library and
CINAHL from inception until December 2022. Studies investigating
associations between preoperative CPET and postoperative outcomes were
included. Risk of bias was assessed using the QUIPS tool. A random effect
model meta-analysis was performed. I2 > 40% indicated a high level of
RESULTS: Thirty-seven studies were included with 6450 patients.
Twenty-eight studies had low risk of bias. [Formula: see text] peak is the
oxygen consumption at peak exercise and serves as a marker of
cardiopulmonary fitness. Higher estimates of [Formula: see text] peak,
measured and as a percentagege of predicted, showed significant
associations with a lower risk of mortality [MD: 3.66, 95% CI: 0.88; 6.43
and MD: 16.49, 95% CI: 6.92; 26.07] and fewer complications [MD: 2.06, 95%
CI: 1.12; 3.00 and MD: 9.82, 95% CI: 5.88; 13.76]. Using a previously
defined cutoff value of > 15mL/kg/min for [Formula: see text] peak, showed
evidence of decreased odds of mortality [OR: 0.55, 95% CI: 0.28-0.81] and
but not decreased odds of postoperative morbidity [OR: 0.82, 95% CI:
0.64-1.00]. There was no relationship between [Formula: see text] slope,
which depicts ventilatory efficiency, with mortality [MD: -9.60, 95% CI:
-27.74; 8.54] however, patients without postoperative complications had a
lower preoperative [Formula: see text] [MD: -2.36, 95% CI: -3.01; -1.71].
Exercise load and anaerobic threshold did not correlate with morbidity or
mortality. There was significant heterogeneity between studies.
CONCLUSIONS: Estimates of cardiopulmonary fitness as evidenced by higher
[Formula: see text] peak, measured and as a percentage of predicted, were
associated with decreased morbidity and mortality. A cutoff value of
[Formula: see text] peak > 15mL/kg/min was consistent with improved
survival but not with fewer complications. Ventilatory efficiency was
associated with decreased postoperative morbidity but not with improved
survival. The heterogeneity in literature could be remedied with large
scale, prospective, blinded, standardised research to improve preoperative
risk stratification in patients with lung cancer scheduled for lung
resection surgery.