Preoperative exercise capacity as a predictor of postoperative pulmonary complications in patients with esophageal cancer: a multicenter observational cohort study

Background Postoperative pulmonary complications (PPCs) after esophageal cancer surgery remain a major concern. Preoperative exercise capacity has emerged as an important predictor. This study examined the clinical use of practical predictors—the 30-s chair stand test (CS-30) and the 6-min walk test (6MWT). Methods We retrospectively analyzed patients with esophageal cancer from three institutions who underwent preoperative physical therapy between July 2021 and June 2023. Data completeness for the CS-30 and 6MWT was compared using McNemar’s test. Three logistic regression models predicting PPCs were developed: Model 1 (established risk factors), Model 2 (risk factors plus CS-30), and Model 3 (risk factors plus 6MWT). PPCs were defined as pneumonia or sputum retention requiring intervention (Clavien–Dindo grade ≥ 2). Model performance was evaluated using the area under the curve (AUC), and incremental predictive value was assessed using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results Among 213 patients (median age 68 years; 83% male), PPCs occurred in 57 (26.8%). Data completeness was significantly higher for the CS-30 (195/213, 91.5%) than the 6MWT (178/213, 83.6%; p < 0.001). The AUCs (95% confidence interval) were 0.775 (0.708–0.842) for Model 1, 0.786 (0.716–0.857) for Model 2, and 0.779 (0.712–0.846) for Model 3. NRI and IDI analyses showed that adding the CS-30 significantly improved reclassification and discrimination abilities. Conclusions The CS-30 was more feasible than the 6MWT and significantly improved PPCs prediction. A perioperative management model for high-risk patients based on the CS-30 is recommended.