Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery

Abstract

Over the past decades, major progress in patient selection, surgical techniques and anaesthetic management have largely contributed to improved outcome in lung cancer surgery. The purpose of this study was to identify predictors of post-operative cardiopulmonary morbidity in patients with a forced expiratory volume in 1 s ,80% predicted, who underwent cardiopulmonary exercise testing (CPET).In this observational study, 210 consecutive patients with lung cancer underwent CPET with completed data over a 9-yr period (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009).Cardiopulmonary complications occurred in 46 (22%) patients, including four (1.9%) deaths. On logistic regression analysis, peak oxygen uptake (peak V9O 2 ) and anaesthesia duration were independent risk factors of both cardiovascular and pulmonary complications; age and the extent of lung resection were additional predictors of cardiovascular complications, whereas tidal volume during one-lung ventilation was a predictor of pulmonary complications. Compared with patients with peak V9O 2 .17 mL?kg, those with a peak V9O 2 ,10 mL?kg -1 ?min -1 had a four-fold higher incidence of cardiac and pulmonary morbidity. Our data support the use of pre-operative CPET and the application of an intra-operative protective ventilation strategy. Further studies should evaluate whether pre-operative physical training can improve post-operative outcome.

Cardiopulmonary Exercise Testing for Predicting Early Outcomes after Major Cancer Resection: A Systematic Review

“…A total of 21 hospital-based cohort studies (12 prospective, 9 retrospective) were included in this review with a total of 4957 patients that underwent CPEX testing prior to lung (12)(13)(14)(15)(16)(17), colorectal (18-20), liver (21-23), oesophagogastric (24-26), bladder (27)(28)(29) and pancreas resection (30-32) ( Figure 1). No studies were found in breast, brain or lymphoma cancers.…”

“…A review of these abstracts identified 23 potentially relevant papers. Six studies met the inclusion criteria and were included in this review (12)(13)(14)(15)(16)(17). All were observational cohort studies (2 prospective, 4 retrospective), with a total of 2814 patients from hospitals within Europe and the USA.…”

“…Such an event is more likely to be associated with intra-operative blood loss (perhaps due to longer operating times in patients with underlying lung disease), suggesting that residual confounding may explain some of the associations found. The other 4 studies in lung cancer patients were all hospital-based cohort studies, which reported inconsistent findings (14)(15)(16)(17). Two of the investigations were by the same research group (15,17), which reported an inverse association between VO2peak and respiratory complications (P = 0.015) in one of their studies (15), but were unable to subsequently replicate this finding (P = 0.5) in the other despite similar methodologies and patient populations (17).…”

Preoperative Peak Oxygen Uptake in Lung Cancer Subjects With Neoadjuvant Chemotherapy: A Cross-Sectional Study

“…2 Peak oxygen uptake (peak V O 2 ), as determined during cardiopulmonary exer-cise testing (CPET), is the reference method to evaluate exercise capacity and predicts early postoperative complications as well as long-term outcome. [3][4][5][6] Besides aging, comorbidities such as COPD, diabetes mellitus, hypertension, peripheral artery disease, and heart failure are highly prevalent in these patients and may all limit aerobic exercise capacity. 7 Moreover, sedentary behavior and the inflammatory component associated with cancer contribute to muscle wasting and decreased peripheral aerobic metabolic capacity.…”

Preoperative exercise heart rate recovery predicts intraoperative hypotension in patients undergoing noncardiac surgery

“…Sympathetic activity may be assessed via muscle microneurography, baroreflex sensitivity, and HR recovery [20,21]. Each of these methods reflects a different aspect of the ANS and is useful in the assessment of peak oxygen uptake, which is predictive of cardiac and pulmonary mortality [22]. Among these, HR recovery is the most promising method.…”