The association between preoperative cardiopulmonary exercise-test variables and short-term morbidity after esophagectomy: A hospital-based cohort study.

Lam S, Alexandre L, Hardwick G, Hart AR

Surgery. 2019 Apr 10. pii: S0039-6060(19)30058-3. doi:
10.1016/j.surg.2019.02.001. [Epub ahead of print]

BACKGROUND: Postoperative complications after esophagectomy are thought to be
associated with reduced fitness. This observational study explored the
associations between aerobic fitness, as determined objectively by preoperative
cardiopulmonary exercise testing (CPEX), and 30-day morbidity after
METHODS: We retrospectively identified 254 consecutive patients who underwent
esophagectomy at a single academic teaching hospital between September 2011 and
March 2017. Postoperative complication data were measured using the Esophageal
Complications Consensus Group definitions and graded using the Clavien-Dindo
classification system of severity (blinded to cardiopulmonary exercise testing
values). Associations between preoperative cardiopulmonary exercise testing
variables and postoperative outcomes were estimated using logistic regression.
RESULTS: A total of 206 patients (77% male) were included in the analyses, with a
mean age of 67 years (SD 9). The mean values for the maximal oxygen consumed at
the peak of exercise (VO2peak) and the anaerobic threshold were 21.1 mL/kg/min
(SD 4.5) and 12.4 mL/kg/min (SD 2.8), respectively. The vast majority of patients
(98.5%) had malignant disease-predominantly adenocarcinoma (84.5%), for which
most received neoadjuvant chemotherapy (79%) and underwent minimally invasive
Ivor Lewis esophagectomy (53%). Complications at postoperative day 30 occurred in
111 patients (54%), the majority of which were cardiopulmonary (72%). No
associations were found between preoperative cardiopulmonary exercise testing
variables and morbidity for either VO2peak (OR 1.00, 95% CI 0.94-1.07) or
anaerobic threshold (OR 0.98, 95% CI 0.89-1.09).
CONCLUSION: Preoperative cardiopulmonary exercise testing variables were not
associated with 30-day complications after esophagectomy. The findings do not
support the use of cardiopulmonary exercise testing as an isolated preoperative
screening tool to predict short-term morbidity after esophagectomy. This modestly
sized observational work highlights the need for larger studies examining
associations between preoperative cardiopulmonary exercise testing and outcomes
after esophagectomy to look for consistency in our findings.