Identifying the limitations of cardiopulmonary exercise testing prior to esophagectomy using a pooled analysis of patient-level data
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
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.
Date Issued
2022-02-09
Date Acceptance
2022-02-01
Citation
Diseases of the Esophagus, 2022, 35 (11), pp.1-10
ISSN
1120-8694
Publisher
Oxford University Press
Start Page
1
End Page
10
Journal / Book Title
Diseases of the Esophagus
Volume
35
Issue
11
Copyright Statement
© 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
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model). This is a pre-copy-editing, author-produced version of an article accepted for publication in Diseases of the Esophagus following peer review. The definitive publisher-authenticated version Jonathan Sivakumar, Matthew J Forshaw, Stephen Lam, Christopher J Peters, William H Allum, Jessica Whibley, Rhona C F Sinclair, Christopher P Snowden, Michael W Hii, Harry Sivakumar, Matthew Read, Identifying the limitations of cardiopulmonary exercise testing prior to esophagectomy using a pooled analysis of patient-level data, Diseases of the Esophagus, Volume 35, Issue 11, November 2022, doac005, https://doi.org/10.1093/dote/doac005
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model). This is a pre-copy-editing, author-produced version of an article accepted for publication in Diseases of the Esophagus following peer review. The definitive publisher-authenticated version Jonathan Sivakumar, Matthew J Forshaw, Stephen Lam, Christopher J Peters, William H Allum, Jessica Whibley, Rhona C F Sinclair, Christopher P Snowden, Michael W Hii, Harry Sivakumar, Matthew Read, Identifying the limitations of cardiopulmonary exercise testing prior to esophagectomy using a pooled analysis of patient-level data, Diseases of the Esophagus, Volume 35, Issue 11, November 2022, doac005, https://doi.org/10.1093/dote/doac005
Identifier
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000756822200001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
cancer
CANCER
esophagectomy
esophagus
Gastroenterology & Hepatology
Life Sciences & Biomedicine
MORBIDITY
NEOADJUVANT CHEMOTHERAPY
OXYGEN-CONSUMPTION
PHYSICAL-FITNESS
PREOPERATIVE EVALUATION
PULMONARY COMPLICATIONS
REFERENCE VALUES
RISK
risk assessment
Science & Technology
SURGERY
Publication Status
Published
Date Publish Online
2022-02-09