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Original Articles: General Thoracic

Is Cardiopulmonary Exercise Testing a Useful Test Before Esophagectomy?

^a Department of General Surgery, St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
^c Department of Anaesthesia, St. Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
^b Department of Respiratory Medicine, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom

Accepted for publication May 22, 2007.

^_* Address correspondence to Mr Mason, Guy’s and St. Thomas’ NHS Foundation Trust, Lambeth Palace Rd, London, SE1 7EH, United Kingdom (Email: robert.mason{at}gstt.nhs.uk).

Background: Cardiopulmonary exercise (CPX) testing may identify patients at high risk of postoperative cardiopulmonary morbidity and mortality. This study aims to assess the utility of CPX testing before esophagectomy.

Methods: Between January 2004 and October 2006, 78 consecutive patients (64 men) with a median age of 65 years (range, 40 to 81 years) underwent CPX testing before esophagectomy (50% transhiatal; 50% transthoracic). Measured variables included anaerobic threshold (AT) and maximum oxygen uptake at peak exercise (O ₂peak). Outcome measures were postoperative morbidity and mortality, length of hospital stay, and unplanned intensive therapy unit admission.

Results: Cardiopulmonary complications occurred in 33 (42%) patients and noncardiopulmonary complications in 19 (24%). One in-hospital death (1.3%) occurred, and 13 patients (17%) required an unplanned intensive therapy unit admission. The level of O ₂peak was significantly lower in patients with postoperative cardiopulmonary morbidity (p = 0.04). The area under a receiver operating characteristic curve was 0.63 (95% confidence interval [CI], 0.50 to 0.76) for the O ₂peak and 0.62 (95% CI, 0.49 to 0.75) for AT. An AT cutoff of 11 mL/kg/min was a poor predictor of postoperative cardiopulmonary morbidity.

Conclusions: Although the O ₂ peak was significantly lower in those patients who developed cardiopulmonary complications, CPX testing is of limited value in predicting postoperative cardiopulmonary morbidity in patients undergoing esophagectomy.

This article has been cited by other articles:

				J. M. Prentis, D. Randles, and C. Snowden The importance of cardiopulmonary exercise testing in the prediction of surgical risk: letter 2. Ann. Thorac. Surg., February 1, 2009; 87(2): 671 - 671. [Full Text] [PDF]

				A. Hall and P. Older Cardiopulmonary exercise testing accurately predicts risk of major surgery including esophageal resection: letter 1. Ann. Thorac. Surg., February 1, 2009; 87(2): 670 - 671. [Full Text] [PDF]

				M. J. Forshaw, D. C. Strauss, A. R. Davies, D. Wilson, B. Lams, A. Pearce, A. J. Botha, and R. C. Mason Reply. Ann. Thorac. Surg., February 1, 2009; 87(2): 671 - 672. [Full Text] [PDF]

				C. M. Danbury, S. O'Neill, A. Kitching, P. Murray, and (on behalf of the authors) Preoperative cardiopulmonary exercise testing Br. J. Anaesth., May 1, 2008; 100(5): 726 - 726. [Full Text] [PDF]