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The Role of Cardiopulmonary Exercise Testing as a Risk Assessment Tool in Patients Undergoing Oesophagectomy: A Systematic Review and Meta-analysis

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Introduction

Cardiopulmonary exercise testing (CPET) is an objective method of assessing functional capacity to meet the metabolic demands of surgery and has been adopted as a preoperative risk-stratification tool for patients undergoing major procedures. The two main measures are the peak rate of oxygen uptake during exercise (\(\dot{{\text{V}}}\)O2peak) and anaerobic threshold (AT), the point at which anaerobic metabolism exceeds aerobic metabolism during exercise. This systematic review and meta-analysis evaluates the predictive value of CPET for patients undergoing oesophagectomy.

Methods

A systematic literature search was conducted in databases of CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, and Scopus to identify studies that examined associations between preoperative CPET variables and postoperative outcomes following oesophagectomy. Results were presented as standardised mean difference (SMD) with 95% confidence interval.

Results

Seven studies were included in this review. Preoperative \(\dot{{\text{V}}}\)O2peak moderately correlated with cardiopulmonary complications [SMD = − 0.43; 95% confidence interval (CI) − 0.77 to − 0.09; p = 0.013; I2 = 80.4%], unplanned ICU admissions (SMD = − 0.34; 95% CI − 0.60 to − 0.08; p = 0.011; I2 = 0.0%), and 1-year survival (SMD = 0.31; 95% CI 0.02–0.61; p = 0.045; I2 = 0.0%). Preoperative AT values moderately correlated with unplanned ICU admissions (SMD = − 0.34; 95% CI − 0.61 to − 0.07; p = 0.014; I2 = 0.0%), and 1-year survival (SMD = 0.34; 95% CI 0.00–0.68; p = 0.049; I2 = 7.4%). Neither \(\dot{{\text{V}}}\)O2peak nor AT demonstrated prognostic value for noncardiopulmonary complications.

Conclusions

\(\dot{{\text{V}}}\)O2peak and AT, where measured by preoperative CPET testing, are inversely associated with postoperative cardiopulmonary complications, unplanned ICU admissions, and 1-year survival following oesophagectomy. This meta-analysis was not able to identify an absolute cutoff value for CPET variables to discriminate between patients of varying levels of operative risk.

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Acknowledgements

The authors acknowledge the substantial contribution of investigators who kindly provided additional data requested from their original manuscripts: Dr. Arfon Powell (Cardiff University School of Medicine, Cardiff) and Dr. Christopher Peters (Imperial College London, St Mary’s Hospital, London).

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Authors and Affiliations

  1. Department of Upper Gastrointestinal Surgery, St Vincent’s Hospital Melbourne, Melbourne, Australia

    Jonathan Sivakumar MBBS, PGDipSurgAnat, MS, Matthew Read MBBS, FRACS & Michael W. Hii MBBS, BMedSci, PGDipSurgAnat, FRACS

  2. Department of Surgery, The University of Melbourne, Melbourne, Australia

    Jonathan Sivakumar MBBS, PGDipSurgAnat, MS & Michael W. Hii MBBS, BMedSci, PGDipSurgAnat, FRACS

  3. Department of Anaesthesia, The Alfred Hospital, Melbourne, Australia

    Harry Sivakumar MBBS, BMedSci (Hons)

  4. Department of Anaesthesia, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    Rhona C. F. Sinclair BMedSci, BMBS, MPhil, MRCP, FRCA

  5. Department of Anaesthesia, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    Chistopher P. Snowden MBBS, FRCA, MD

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  1. Jonathan Sivakumar MBBS, PGDipSurgAnat, MS
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Correspondence to Jonathan Sivakumar MBBS, PGDipSurgAnat, MS.

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Sivakumar, J., Sivakumar, H., Read, M. et al. The Role of Cardiopulmonary Exercise Testing as a Risk Assessment Tool in Patients Undergoing Oesophagectomy: A Systematic Review and Meta-analysis. Ann Surg Oncol 27, 3783–3796 (2020). https://doi.org/10.1245/s10434-020-08638-9

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