Assessment of Exercise Oxygen Consumption as Preoperative Criterion for Lung Resection

Bechard, Daniel E.; Wetstein, Lewis

doi:10.1016/s0003-4975(10)63787-3

Cited by 194 publications

(69 citation statements)

References 15 publications

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“…No correlation was found between the rate of complication and the size of the resection. Other studies have used V 'O 2 ,max as a proportion of body mass <20 mL·kg -1 ·min -1 as the cut-off [23]. In the present study, all five cardiopulmonary deaths had a V 'O 2 ,max <20 mL·kg -1 ·min -1 , whereas 52% of the survivors were below this limit.…”

Section: Resultsmentioning

confidence: 46%

“…There has been debate about the clinical significance of exercise testing in preoperative evaluation, and there are conflicting results from the literature concerning the applicability of a symptom-limited exercise test. Some papers advocate the exercise test as a good predictor of postoperative complications [16,19,[21][22][23][24][25][26] and others do not [12,[27][28][29]. The studies differ in design, number of participating patients, registration of complications and statistical methods.…”

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confidence: 99%

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Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma

Larsen¹,

Ug²,

Milman³

et al. 1997

Eur Respir J

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The aim of this study was to evaluate which parameters of preoperative spirometry and cardiopulmonary exercise test are the best predictors of postoperative morbidity and mortality in patients with bronchogenic carcinoma.Ninety seven patients were prospectively and consecutively examined. All patients had preoperative maximal exercise test and dynamic spirometry. Postoperative complications and causes of death were registered. Logistic regression was used and models explaining the relationship between preoperative variables and postoperative complications and deaths were constructed.We found significant differences in preoperative maximal workload and carbon dioxide output between groups, with and without cardiopulmonary-related complications, but not in spirometry variables. Logistic regression showed maximal workload to be the only predictor of cardiopulmonary complications. Maximal oxygen uptake was predictive of cardiopulmonary deaths. Maximal oxygen uptake and forced expiratory volume were predictive of postoperative complications. A maximal oxygen uptake <50% predicted was associated with high risk of death from cardiopulmonary causes. Kaplan-Meier survival curves showed that maximal oxygen uptake was correlated to long-term survival, while spirometric variables were not.Exercise testing can be used in the preoperative evaluation of patients with nonmetastatic bronchogenic carcinoma. A combination of the results of variables from spirometry and exercise testing is proposed to be used as a preoperative criterion for operability. Eur Respir J 1997; 10: 1559-1565 Carcinoma of the lung is one of the most common causes of death due to cancer in men, and is increasingly common in women. Some 900,000 new cases are reported worldwide every year [1]. The prognosis in untreated cases is poor, and at present the major curative treatment modality for non-small cell carcinoma is resection. The removal of lung parenchyma from patients, who are usually smokers with compromised cardiovascular or pulmonary status, may lead to cardiopulmonary failure or death. Many variables have been used to assess the risk of postoperative complications, but it is not clear which of these parameters in preoperative pulmonary function testing are the best predictors of the operative outcome. Many centres recommend operation without additional testing in patients with a forced expiratory volume in one second (FEV1) >2.0 L or 60% of predicted and a diffusing capacity >60% pred [2][3][4][5][6]. If these requirements are not met, a perfusion or ventilation scan is performed, and the predicted postoperative FEV1 (FEV1,ppo) is estimated. The accuracy of these methods is proven [7][8][9][10][11] and it seems generally accepted that a FEV1,ppo of 0.8-1.0 L or 30% pred represents the lower limits of acceptable risk [4][5][6][12][13][14][15][16][17]. Some recommend different limits for different resections [18]. In spite of this consensus for identifying patients at risk, about 30% develop cardiopulmonary complications with a 30 day mortal...

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Section: Resultsmentioning

confidence: 46%

mentioning

confidence: 99%

Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma

Larsen¹,

Ug²,

Milman³

et al. 1997

Eur Respir J

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“…For the sake of comparison, the same definition for postoperative complications as used by SMITH et al [7], BECHARD and WETSTEIN [8], MARKOS et al [12] and BOLLIGER et al [9] was applied (table 2).…”

Section: Postoperative Complicationsmentioning

confidence: 99%

“…However, in different studies, different exercise parameters and different recommendations are given. EUGENE et al [6] underlined the importance of the absolute value of maximal oxygen uptake (V 'O 2 ,max); SMITH et al [7] and BECHARD and WETSTEIN [8] found V 'O 2 ,max . kg body weight -1 to be the best parameter; BOLLIGER et al [9,10] underlined the importance of poor exercise performance and especially V 'O 2 ,max .…”

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confidence: 99%

Exercise capacity and extent of resection as predictors of surgical risk in lung cancer

Spiliopoulos²,

et al. 2000

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Lung resection remains the most effective treatment for non-small cell lung cancer (NSCLC). However, there is no consensus about reliable operative risk assessment in these patients. The aim of this study was to identify predictors of postoperative complications and death after lung resection for NSCLC.In this prospective trial, 125 of 142 (88%) consecutive NSCLC patients from 1990 to August 1997 had complete data sets. All underwent functional assessment including spirometry and cardiopulmonary exercise tests and lung resection via thoracotomy.Complications occurred in 31 of 125 (25%) patients including 2 (1.6%) deaths. On logistic regression analysis, only maximal oxygen uptake (V 'O 2 ,max) . kg body weight -1 expressed as a percentage of the predicted value (p<0.0001) and the estimated extent of lung tissue resection (p=0.02) were independent predictors of postoperative complications. Six of seven patients with a V 'O 2 ,max . kg body weight -1 of <60% pred, but only eight of 65 with values >90% pred, exhibited postoperative complications.Maximal oxygen uptake and the estimated extent of lung tissue resection are independent predictors of postoperative complications. These simple parameters should be integrated into the preoperative decision analysis for operability in patients undergoing lung resection for lung cancer. Eur Respir J 2000; 15: 828±832.

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“…Several small studies in the 80's and early 90's found an association between low VO 2 max and mortality after lung resection (46)(47)(48). In 1995, Bolliger et al demonstrated that the probability of developing complications in patients with a VO 2 max greater than 75% of predicted was only 10% whereas the probability of developing complications was as high as 90% in those with VO 2 max below 40% of predicted (49).…”

Section: Cardiopulmonary Exercise Test (Cpet)mentioning

confidence: 99%

Preoperative functional workup for patients with advanced lung cancer

Brunelli

2016

J. Thorac. Dis.

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Locally advanced lung cancer remains a surgical indication in selected patients. This condition often demands larger resections. As a consequence preoperative functional workup is of paramount importance to stratify the risk and choose the most appropriate treatment. We reviewed the current evidence on functional evaluation with a special focus on specific aspects related to locally advanced lung cancer stages (i.e., risk after neoadjuvant treatment, pneumonectomy). Evidence is discussed to provide information that could assist clinicians in their preoperative workup of these challenging patients.

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Assessment of Exercise Oxygen Consumption as Preoperative Criterion for Lung Resection

Cited by 194 publications

References 15 publications

Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma

Exercise testing in the preoperative evaluation of patients with bronchogenic carcinoma

Exercise capacity and extent of resection as predictors of surgical risk in lung cancer

Preoperative functional workup for patients with advanced lung cancer

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