Key result
Preoperative peak VO2 <15 mL/kg/min is linked to ~161% higher complication risk in lung cancer surgery.
Why the study?
Current CPET guidelines for lung cancer surgery rely on expert consensus and scientific statements, lacking robust, graded evidence.
Do pre-surgery CPET variables predict perioperative morbidity and long-term mortality in patients undergoing lung cancer surgery?
Systematic Review (n=11,356)
Do pre-surgery CPET variables predict perioperative morbidity and long-term mortality in patients undergoing lung cancer surgery?
Odds Ratio: 2.61 (95% CI 1.76–3.86)
p-value: p=<0.001
Preoperative CPET variables, specifically peak VO2 <15 mL/kg/min and VE/VCO2 slope >35, are supported by high-certainty evidence as predictors of perioperative complications in lung cancer surgery.
Supports preoperative CPET for risk stratification in lung cancer surgery; extends high-certainty meta-analytic evidence for peak VO2 threshold.
Current cardiopulmonary exercise testing (CPET) guidelines for lung cancer surgery rely on expert consensus and scientific statements, lacking robust, graded evidence. This study aimed to provide an evidence-based evaluation of CPET variables for assessing perioperative morbidity and long-term mortality risks. Electronic databases were searched through December 20, 2025, for cohort studies on CPET variables and lung cancer surgery. Quality was assessed using the Newcastle-Ottawa Scale. Heterogeneity was evaluated by the Q -test and I 2 statistic, with fixed or random effects models. Publication bias was assessed via funnel plots and Egger’s test, with adjustment using the trim-and-fill method when necessary. Effect sizes were pooled, and evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Of 3080 studies, 47 studies involving 11,356 surgeries and 13 CPET variables were included. Meta-analysis and GRADE assessment showed lower peak oxygen uptake (peak \(V̇\) O₂) increased the risk of perioperative complications by 2.04–3.02 times ( P < 0.001), using a cutoff point of 15 mL/kg/min or peak \(V̇\) O 2 expressed as %pred. A higher minute ventilation to carbon dioxide production ( \(V̇\) E/ \(V̇\) CO₂) slope was associated with a 2.44-fold increased risk (95% CI [1.82–3.27], P < 0.001), with a cutoff point of 35 (high-level). Limited studies suggest peak \(V̇\) O₂ (L/min) and \(V̇\) E/ \(V̇\) CO₂ slope relate to cancer-specific and all-cause mortality. Evidence for variables such as \(V̇\) O₂ at anaerobic threshold and peak ventilation remains low. Among 13 CPET variables, only peak \(V̇\) O₂ (15 mL/kg/min or %pred values) and \(V̇\) E/ \(V̇\) CO₂ slope (35) are supported by high-certainty evidence for perioperative risk. Further studies are needed to establish CPET’s role in predicting cancer-specific mortality in lung cancer surgery. PROSPERO CRD42023405083.
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Dun et al. (2026) conducted a systematic review in Lung cancer (n=11,356). Peak oxygen uptake (VO2) < 15 mL/kg/min vs. Peak oxygen uptake (VO2) > 15 mL/kg/min was evaluated on Perioperative complications (OR 2.61, 95% CI 1.76-3.86, p=<0.001). A preoperative peak oxygen uptake below 15 mL/kg/min was associated with a 2.61-fold increased risk of perioperative complications in patients undergoing lung cancer surgery.
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