Identifying the limitations of cardiopulmonary exercise testing prior to esophagectomy using a pooled analysis of patient-level data.

Autor: Sivakumar J; Department of Surgery, The University of Melbourne, Melbourne, Australia.; Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia., Forshaw MJ; Department of Upper Gastrointestinal Surgery, Glasgow Royal Infirmary, Glasgow, UK., Lam S; Department of Upper Gastrointestinal Surgery, Norfolk and Norwich University Hospital, Norwich, UK., Peters CJ; Department of Surgery and Cancer, Imperial College London of St Mary's Hospital, London, UK., Allum WH; Department of Surgery, Royal Marsden Hospital, London, UK., Whibley J; Department of Physiotherapy, Royal Marsden Hospital, London, UK., Sinclair RCF; Department of Anaesthesia, Royal Victoria Infirmary, Newcastle Upon Tyne, UK., Snowden CP; Department of Anaesthesia, Freeman Hospital, Newcastle Upon Tyne, UK., Hii MW; Department of Surgery, The University of Melbourne, Melbourne, Australia.; Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia., Sivakumar H; Department of Anaesthesia, The Alfred Hospital, Melbourne, Australia., Read M; Department of Surgery, The University of Melbourne, Melbourne, Australia.; Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia.
Jazyk: angličtina
Zdroj: Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus [Dis Esophagus] 2022 Nov 15; Vol. 35 (11).
DOI: 10.1093/dote/doac005
Abstrakt: Preoperative cardiopulmonary exercise testing (CPET) provides an objective assessment of aerobic fitness in patients undergoing surgery. While peak oxygen uptake during exercise (VO2peak) and anaerobic threshold have demonstrated a moderate correlation with the development of complications following esophagectomy, no clinically useful threshold values have been defined. By pooling patient level data from existing studies, we aimed to define optimal thresholds for preoperative CPET parameters to predict patients at high risk of postoperative complications. Studies reporting on the relationship between preoperative CPET variables and post-esophagectomy complications were determined from a comprehensive literature search. Patient-level data were obtained from six contributing centers for pooled-analyses. Outcomes of interest included cardiopulmonary and non-cardiopulmonary complications, unplanned intensive care unit readmission, and 90-day and 12-month all-cause mortality. Receiver operating characteristic curves and logistic regression models estimated the predictive value of CPET parameters for each individual outcome of interest. This analysis comprised of 621 patients who underwent CPET prior to esophagectomy during the period from January 2004 to March 2017. For both anaerobic threshold and VO2peak, none of the receiver operating characteristic curves achieved an area under the curve value > 0.66 for the outcomes of interest. The discriminatory ability of CPET for determining high-risk patients was found to be poor in patients undergoing an esophagectomy. CPET may only carry an adjunct role to clinical decision-making.
(© The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze: MEDLINE
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