Jonathan Sivakumar1,2, Harry Sivakumar3, Matthew Read4, Rhona C F Sinclair5, Chistopher P Snowden6, Michael W Hii4,7. 1. Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia. sivakumar.jonathan@gmail.com. 2. Department of Surgery, The University of Melbourne, Melbourne, Australia. sivakumar.jonathan@gmail.com. 3. Department of Anaesthesia, The Alfred Hospital, Melbourne, Australia. 4. Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia. 5. Department of Anaesthesia, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. 6. Department of Anaesthesia, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. 7. Department of Surgery, The University of Melbourne, Melbourne, Australia.
Abstract
INTRODUCTION: Cardiopulmonary exercise testing (CPET) is an objective method of assessing functional capacity to meet the metabolic demands of surgery and has been adopted as a preoperative risk-stratification tool for patients undergoing major procedures. The two main measures are the peak rate of oxygen uptake during exercise ([Formula: see text]O2peak) and anaerobic threshold (AT), the point at which anaerobic metabolism exceeds aerobic metabolism during exercise. This systematic review and meta-analysis evaluates the predictive value of CPET for patients undergoing oesophagectomy. METHODS: A systematic literature search was conducted in databases of CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, and Scopus to identify studies that examined associations between preoperative CPET variables and postoperative outcomes following oesophagectomy. Results were presented as standardised mean difference (SMD) with 95% confidence interval. RESULTS: Seven studies were included in this review. Preoperative [Formula: see text]O2peak moderately correlated with cardiopulmonary complications [SMD = - 0.43; 95% confidence interval (CI) - 0.77 to - 0.09; p = 0.013; I2 = 80.4%], unplanned ICU admissions (SMD = - 0.34; 95% CI - 0.60 to - 0.08; p = 0.011; I2 = 0.0%), and 1-year survival (SMD = 0.31; 95% CI 0.02-0.61; p = 0.045; I2 = 0.0%). Preoperative AT values moderately correlated with unplanned ICU admissions (SMD = - 0.34; 95% CI - 0.61 to - 0.07; p = 0.014; I2 = 0.0%), and 1-year survival (SMD = 0.34; 95% CI 0.00-0.68; p = 0.049; I2 = 7.4%). Neither [Formula: see text]O2peak nor AT demonstrated prognostic value for noncardiopulmonary complications. CONCLUSIONS: [Formula: see text]O2peak and AT, where measured by preoperative CPET testing, are inversely associated with postoperative cardiopulmonary complications, unplanned ICU admissions, and 1-year survival following oesophagectomy. This meta-analysis was not able to identify an absolute cutoff value for CPET variables to discriminate between patients of varying levels of operative risk.
INTRODUCTION: Cardiopulmonary exercise testing (CPET) is an objective method of assessing functional capacity to meet the metabolic demands of surgery and has been adopted as a preoperative risk-stratification tool for patients undergoing major procedures. The two main measures are the peak rate of oxygen uptake during exercise ([Formula: see text]O2peak) and anaerobic threshold (AT), the point at which anaerobic metabolism exceeds aerobic metabolism during exercise. This systematic review and meta-analysis evaluates the predictive value of CPET for patients undergoing oesophagectomy. METHODS: A systematic literature search was conducted in databases of CINAHL, Cochrane Library, EMBASE, MEDLINE, PubMed, and Scopus to identify studies that examined associations between preoperative CPET variables and postoperative outcomes following oesophagectomy. Results were presented as standardised mean difference (SMD) with 95% confidence interval. RESULTS: Seven studies were included in this review. Preoperative [Formula: see text]O2peak moderately correlated with cardiopulmonary complications [SMD = - 0.43; 95% confidence interval (CI) - 0.77 to - 0.09; p = 0.013; I2 = 80.4%], unplanned ICU admissions (SMD = - 0.34; 95% CI - 0.60 to - 0.08; p = 0.011; I2 = 0.0%), and 1-year survival (SMD = 0.31; 95% CI 0.02-0.61; p = 0.045; I2 = 0.0%). Preoperative AT values moderately correlated with unplanned ICU admissions (SMD = - 0.34; 95% CI - 0.61 to - 0.07; p = 0.014; I2 = 0.0%), and 1-year survival (SMD = 0.34; 95% CI 0.00-0.68; p = 0.049; I2 = 7.4%). Neither [Formula: see text]O2peak nor AT demonstrated prognostic value for noncardiopulmonary complications. CONCLUSIONS: [Formula: see text]O2peak and AT, where measured by preoperative CPET testing, are inversely associated with postoperative cardiopulmonary complications, unplanned ICU admissions, and 1-year survival following oesophagectomy. This meta-analysis was not able to identify an absolute cutoff value for CPET variables to discriminate between patients of varying levels of operative risk.
Authors: P van Hagen; M C C M Hulshof; J J B van Lanschot; E W Steyerberg; M I van Berge Henegouwen; B P L Wijnhoven; D J Richel; G A P Nieuwenhuijzen; G A P Hospers; J J Bonenkamp; M A Cuesta; R J B Blaisse; O R C Busch; F J W ten Kate; G-J Creemers; C J A Punt; J T M Plukker; H M W Verheul; E J Spillenaar Bilgen; H van Dekken; M J C van der Sangen; T Rozema; K Biermann; J C Beukema; A H M Piet; C M van Rij; J G Reinders; H W Tilanus; A van der Gaast Journal: N Engl J Med Date: 2012-05-31 Impact factor: 91.245
Authors: Damien J Lapar; George J Stukenborg; Christine L Lau; David R Jones; Benjamin D Kozower Journal: J Thorac Cardiovasc Surg Date: 2012-08-29 Impact factor: 5.209
Authors: Donald E Low; Madhan Kumar Kuppusamy; Derek Alderson; Ivan Cecconello; Andrew C Chang; Gail Darling; Andrew Davies; Xavier Benoit D'Journo; Suzanne S Gisbertz; S Michael Griffin; Richard Hardwick; Arnulf Hoelscher; Wayne Hofstetter; Blair Jobe; Yuko Kitagawa; Simon Law; Christophe Mariette; Nick Maynard; Christopher R Morse; Philippe Nafteux; Manuel Pera; C S Pramesh; Sonia Puig; John V Reynolds; Wolfgang Schroeder; Mark Smithers; B P L Wijnhoven Journal: Ann Surg Date: 2019-02 Impact factor: 12.969
Authors: Freddie Bray; Jacques Ferlay; Isabelle Soerjomataram; Rebecca L Siegel; Lindsey A Torre; Ahmedin Jemal Journal: CA Cancer J Clin Date: 2018-09-12 Impact factor: 508.702
Authors: David Cunningham; William H Allum; Sally P Stenning; Jeremy N Thompson; Cornelis J H Van de Velde; Marianne Nicolson; J Howard Scarffe; Fiona J Lofts; Stephen J Falk; Timothy J Iveson; David B Smith; Ruth E Langley; Monica Verma; Simon Weeden; Yu Jo Chua Journal: N Engl J Med Date: 2006-07-06 Impact factor: 91.245
Authors: Chris P Snowden; James Prentis; Byron Jacques; Helen Anderson; Derek Manas; Dave Jones; Michael Trenell Journal: Ann Surg Date: 2013-06 Impact factor: 12.969
Authors: Maryam Ozova; Petr Chomakhidze; Maria Poltavskaya; Dmitry Vychuzhanin; Philippe Kopylov; Hugo Saner; Denis Andreev Journal: Open Heart Date: 2022-07
Authors: Jakub Chmelo; Alexander W Phillips; Alastair Greystoke; Sarah J Charman; Leah Avery; Kate Hallsworth; Jenny Welford; Matthew Cooper; Rhona C F Sinclair Journal: Pilot Feasibility Stud Date: 2022-08-09
Authors: Daniel Steffens; Hilmy Ismail; Linda Denehy; Paula R Beckenkamp; Michael Solomon; Cherry Koh; Jenna Bartyn; Neil Pillinger Journal: Ann Surg Oncol Date: 2021-06-08 Impact factor: 5.344