Preoperative Cardiopulmonary Exercise Test Associated with Postoperative Outcomes in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analyses

Steffens, Daniel; Ismail, Hilmy; Denehy, Linda; Beckenkamp, Paula R.; Solomon, Michael J.; Koh, Cherry; Bartyn, Jenna; Pillinger, Neil

doi:10.1245/s10434-021-10251-3

Cited by 55 publications

(40 citation statements)

References 70 publications

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“…Several reviews of preoperative function and postoperative outcomes have been conducted in the setting of other functional assessment tools such as CPET or self‐reported physical activity over the last 5 years 1,39–41 . The most recent and extensive review of CPET in the context of cancer surgery was conducted by Steffens et al .…”

Section: Discussionmentioning

confidence: 99%

“…Several reviews of preoperative function and postoperative outcomes have been conducted in the setting of other functional assessment tools such as CPET or self-reported physical activity over the last 5 years. 1,[39][40][41] The most recent and extensive review of CPET in the context of cancer surgery was conducted by Steffens et al (2021), which included 52 unique studies and involved 10 030 patients. 41 This study found that a higher preoperative peak oxygen uptake (measured during CPET) was associated with the absence of postoperative complications (MD = 2.28; 95% CI = 1.26-3.29) and no pulmonary complications (MD = 1.47; 95% CI = 0.49 to 2.45).…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…1,[39][40][41] The most recent and extensive review of CPET in the context of cancer surgery was conducted by Steffens et al (2021), which included 52 unique studies and involved 10 030 patients. 41 This study found that a higher preoperative peak oxygen uptake (measured during CPET) was associated with the absence of postoperative complications (MD = 2.28; 95% CI = 1.26-3.29) and no pulmonary complications (MD = 1.47; 95% CI = 0.49 to 2.45). Earlier CPET studies conducted by Lee et CPET, whilst informative, is an expensive and resource intensive tool that can be difficult to administer in the clinical setting as it requires involvement of trained professionals and specialized equipment.…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

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Preoperative functional capacity and postoperative outcomes following abdominal and pelvic cancer surgery: a systematic review and meta‐analysis

Makker

Koh

Solomon

et al. 2022

ANZ Journal of Surgery

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Background: There is clinical uncertainty regarding an association between preoperative functional capacity of cancer patients, and postoperative outcomes. The aim of this systematic review and meta-analysis is to investigate whether poor performance on preoperative six-minute walk test (6MWT) or five-times sit to stand test (5STS) is associated with worse postoperative complication rates and prolonged length of hospital stay (LOS) in cancer patients. Methods: An electronic search was performed from earliest available record to 26th February 2021 in MEDLINE, Embase and AMED. Studies investigating the association between preoperative physical function (measured using either 6MWT or 5STS) and postoperative outcomes (complications and LOS) in patients with gastrointestinal, abdominal and pelvic cancers were included. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Where possible, summary odds ratios (OR) or mean differences (MD), and 95% confidence intervals (CI) were calculated using random-effect models. Results: Five studies (379 patients) were included, of which none utilized the 5STS. Overall, studies were rated as having low to moderate risk of bias. Higher preoperative performance on the 6MWT (≥400 m) was associated with low grade postoperative complications (OR = 0.38; 95% CI = 0.15-0.95) but was not associated with a shorter LOS (MD = 3.29; 95%CI = À1.07-7.66). Conclusion:The available evidence suggests that in cancer patients, a higher preoperative functional capacity may be associated with reduced postoperative complications. Conversely, there is no significant association between preoperative function and LOS. Further high-quality studies are needed in this area, including studies involving 5STS.

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Section: Discussionmentioning

confidence: 99%

Section: Comparison With Other Studiesmentioning

confidence: 99%

Section: Comparison With Other Studiesmentioning

confidence: 99%

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Preoperative functional capacity and postoperative outcomes following abdominal and pelvic cancer surgery: a systematic review and meta‐analysis

Makker

Koh

Solomon

et al. 2022

ANZ Journal of Surgery

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“…Some systematic review and meta-analysis studies demonstrated that superior preoperative CPET values, especially peak VO2, were significantly associated with improved postoperative outcomes in patients undergoing cancer surgery ( 41 ). The reason for this phenomenon remains uncertain but is gradually being elucidated.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery

Chao

Tuan²,

Tang³

et al. 2022

Front. Med.

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ObjectivesPatients with lung cancer pose a high risk of morbidity and mortality after lung resection. Those who receive perioperative cardiopulmonary rehabilitation (PRCR) have better prognosis. Peak oxygen consumption (peak VO2), VO2 at the ventilatory threshold (VO2 at VT), and slope of minute ventilation to carbon dioxide production (VE/VCO2 slope) measured during pre-surgical cardiopulmonary exercise testing (CPET) have prognostic values after lung resection. We aimed to investigate the influence of individualized PRCR on postoperative complications in patients undergoing video-assisted thoracic surgery (VATS) for lung cancer with different pre-surgical risks.MethodsThis was a retrospective study. We recruited 125 patients who underwent VATS for lung cancer between 2017 and 2021. CPET was administered before surgery to evaluate the risk level and PRCR was performed based on the individual risk level defined by peak VO2, VO2 at VT, and VE/VCO2 slope, respectively. The primary outcomes were intensive care unit (ICU) and hospital lengths of stay, endotracheal intubation time (ETT), and chest tube insertion time (CTT). The secondary outcomes were postoperative complications (PPCs), including subcutaneous emphysema, pneumothorax, pleural effusion, atelectasis, infection, and empyema.ResultsThree intergroup comparisons based on the risk level by peak VO2 (3 groups), VO2 at VT (2 groups), and VE/VCO2 slope (3 groups) were done. All of the comparisons showed no significant differences in both the primary and secondary outcomes (p = 0.061–0.910).ConclusionPatients with different risk levels showed comparable prognosis and PPCs after undergoing CPET-guided PRCR. PRCR should be encouraged in patients undergoing VATS for lung cancer.

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“…One of the best predictors of postoperative morbidity and mortality after major abdominal surgery is reduced physical fitness measured by low oxygen uptake [ 20 , 21 ], which potentially can be improved through training. Individualized high-intensity interval training (HIIT) has been shown to be a reliable way to improve physical fitness [ 22 , 23 ]; however, it is not clear if a short course of HIIT can improve physical fitness in elderly and frail patients with colorectal cancer prior to surgery.…”

Section: Introductionmentioning

confidence: 99%

Fit for Surgery—feasibility of short-course multimodal individualized prehabilitation in high-risk frail colon cancer patients prior to surgery

Bojesen

Jørgensen

Grube

et al. 2022

Pilot Feasibility Stud

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Background Prehabilitation is a promising modality for improving patient-related outcomes after major surgery; however, very little research has been done for those who may need it the most: the elderly and the frail. This study aimed to investigate the feasibility of a short course multimodal prehabilitation prior to primary surgery in high-risk, frail patients with colorectal cancer and WHO performance status I and II. Methods The study was conducted as a single-center, prospective one-arm feasibility study of eight patients with colon cancer between October 4, 2018, and January 14, 2019. The intervention consisted of a physical training program tailored to the patients with both high-intensity interval training and resistance training three times a week in sessions of approximately 1 h in length, for a duration of at least 4 weeks, nutritional support with protein and vitamins, a consultation with a dietician, and medical optimization prior to surgery. Feasibility was evaluated regarding recruitment, retention, compliance and adherence, acceptability, and safety. Retention was evaluated as the number of patients that completed the intervention, with a feasibility goal of 75% completing the intervention. Compliance with the high-intensity training was evaluated as the number of sessions in which the patient achieved a minimum of 4 min > 90% of their maximum heart rate and adherence as the attended out of the offered training sessions. Results During the study period, 64 patients were screened for eligibility, and out of nine eligible patients, eight patients were included and seven completed the intervention (mean age 80, range 66–88). Compliance to the high-intensity interval training using 90% of maximum heart rate as the monitor of intensity was difficult to measure in several patients; however, adherence to the training sessions was 87%. Compliance with nutritional support was 57%. Half the patients felt somewhat overwhelmed by the multiple appointments and six out of seven reported difficulties with the dosage of protein. Conclusions This one-arm feasibility study indicates that multimodal prehabilitation including high-intensity interval training can be performed by patients with colorectal cancer and WHO performance status I and II. Trial registration Clinicaltrials.gov: the study current feasibility study was conducted prior to the initiation of a full ongoing randomized trial registered by NCT04167436; date of registration: November 18, 2019. Retrospectively registered. No separate prospectively registration of the feasibility trial was conducted but outlined by the approved study protocol (Danish Scientific Ethical Committee SJ-607).

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Preoperative Cardiopulmonary Exercise Test Associated with Postoperative Outcomes in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analyses

Cited by 55 publications

References 70 publications

Preoperative functional capacity and postoperative outcomes following abdominal and pelvic cancer surgery: a systematic review and meta‐analysis

Preoperative functional capacity and postoperative outcomes following abdominal and pelvic cancer surgery: a systematic review and meta‐analysis

Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery

Fit for Surgery—feasibility of short-course multimodal individualized prehabilitation in high-risk frail colon cancer patients prior to surgery

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