What is the clinical evidence from this study?

Study design: Observational. Population: Rectal cancer (n=95). Intervention: Cardiopulmonary exercise testing (CPET). Primary outcome: In-hospital morbidity (AUC 0.87, 95% CI 0.78 to 0.95, p=<0.001).

What does this research mean for the field?

Preoperative cardiopulmonary exercise testing, specifically oxygen uptake at the lactate threshold, accurately predicts postoperative morbidity risk in patients undergoing rectal cancer surgery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 11, 2014Open Access

Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery

Q: What are the key findings of this study?

Preoperative cardiopulmonary exercise testing, specifically oxygen uptake at lactate threshold, predicted postoperative morbidity after rectal cancer surgery (AUC 0.87; 95% CI 0.78-0.95; P<0.001).

Q: What does this research mean for the field?

Preoperative cardiopulmonary exercise testing, specifically oxygen uptake at the lactate threshold, accurately predicts postoperative morbidity risk in patients undergoing rectal cancer surgery. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Preoperative cardiopulmonary exercise testing, specifically oxygen uptake at lactate threshold, predicted postoperative morbidity after rectal cancer surgery (AUC 0.87; 95% CI 0.78-0.95; P<0.001).

Study Design

Type

Observational (n=95)

Blinding

Double-blind assessment

Structured PICO

Does preoperative cardiopulmonary exercise testing predict in-hospital morbidity in patients undergoing rectal cancer surgery?

Population

95 patients scheduled for rectal cancer surgery (72 men), of whom 68 received neoadjuvant treatment.

Intervention

Preoperative cardiopulmonary exercise testing (CPET)

Outcome

In-hospital morbidityhard clinical

Preoperative cardiopulmonary exercise testing can help predict in-hospital morbidity after rectal cancer surgery.

Main Result

Effect estimate: AUC 0.87 (95% CI 0.78 to 0.95)

p-value: p=<0.001

Abstract

BACKGROUND: This study investigated the relationship between objectively measured physical fitness variables derived by cardiopulmonary exercise testing (CPET) and in-hospital morbidity after rectal cancer surgery. METHODS: Patients scheduled for rectal cancer surgery underwent preoperative CPET (reported blind to patient characteristics) with recording of morbidity (recorded blind to CPET variables). Non-parametric receiver operating characteristic (ROC) curves and logistic regression were used to assess the relationship between CPET variables and postoperative morbidity. RESULTS: Of 105 patients assessed, 95 (72 men) were included; ten patients had no surgery and were excluded (3 by choice, 7 owing to unresectable metastasis). Sixty-eight patients had received neoadjuvant treatment. ROC curve analysis of oxygen uptake (V˙o2) at estimated lactate threshold (θL) and peak V˙o2 gave an area under the ROC curve of 0·87 (95 per cent confidence interval 0·78 to 0·95; P < 0·001) and 0·85 (0·77 to 0·93; P < 0·001) respectively, indicating that they can help discriminate patients at risk of postoperative morbidity. The optimal cut-off points identified were 10·6 and 18·6 ml per kg per min for V˙o2 at θL and peak respectively. CONCLUSION: CPET can help predict morbidity after rectal cancer surgery.