Key result
Neoadjuvant chemotherapy linked to ~2.5 mL/kg/min decline in anaerobic threshold, correlating with severe complications.
Why the study?
Neoadjuvant chemotherapy improves oesophageal cancer resectability but may reduce exercise capacity and adversely affect postoperative outcomes, which can be assessed using cardiopulmonary exercise testing.
Does cardiopulmonary exercise testing (CPET) functional reserve predict postoperative outcomes in esophageal cancer patients undergoing neoadjuvant chemotherapy followed by surgery?
Observational (n=33)
Open-label
No
Does cardiopulmonary exercise testing (CPET) functional reserve predict postoperative outcomes in esophageal cancer patients undergoing neoadjuvant chemotherapy followed by surgery?
Cardiopulmonary exercise testing reveals that neoadjuvant chemotherapy significantly diminishes anaerobic threshold, a physiological decline that accurately predicts severe postoperative complications in patients undergoing esophagectomy.
Answers are grounded in this paper and cite their sources.
Neoadjuvant chemotherapy-linked anaerobic threshold decline signals higher complication risk; leaves open whether CPET improves esophagectomy risk stratification.
OBJECTIVE: Neoadjuvant chemotherapy improves resectability rates of oesophageal cancer, but the process may also take a toll on the patients' exercise capacity and may adversely affect the postoperative outcomes. It can be assessed objectively using cardiopulmonary exercise testing. METHODS: Patients with oesophagus cancer performed a baseline test and a second test after neoadjuvant chemotherapy during the week preceding oesophagectomy. They were followed up for postoperative complications, length of hospital stay, and 30-day mortality. RESULTS: Thirty-three patients completed the study. The mean pre-chemotherapy peak oxygen uptake (VO2 peak) was 1128.39 ± 202.79 mL min-1 (19.46 ± 3.06 mL kg-1 min-1 ) which declined to 1010.33 ± 195.56 mL min-1 (17.24 ± 2.55 mL kg-1 min-1 ) in the postchemotherapy period (P < .001). Pre-chemotherapy anaerobic threshold was 906.85 ± 176.81 mL min-1 (15.54 ± 2.24 mL kg-1 min-1 ) which declined to 764.76 ± 158.79 mL min-1 (13.01 ± 2.22 mL kg-1 min-1 ) (P < .001) in the post-chemotherapy period. Six patients developed complications of modified Clavien-Dindo grade 3 and above. Two (6.1%) patients succumbed to complications within 30 days. The mean anaerobic threshold in patients who suffered complications modified Clavien-Dindo grade ≥3 was 693.33 ± 140.99 mL min-1 (11.2 ± 1.17 mL kg-1 min-1 ) while patients with mild to moderate complications had a mean anaerobic threshold 13.41 ± 2.21 mL kg-1 min-1 (P < .006). An optimal cut off value for anaerobic threshold was 12.5 mL kg-1 min-1 Conclusion: Cardiopulmonary exercise testing accurately predicts outcomes in cancer oesophagus patients who undergo neoadjuvant chemotherapy followed by surgery.
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Suri et al. (2022) conducted an observational in Oesophageal Cancer (n=33). Neoadjuvant chemotherapy vs. Baseline (Pre-chemotherapy) was evaluated on Mean anaerobic threshold (AT) (p=<0.001). Neoadjuvant chemotherapy reduced mean anaerobic threshold from 15.54 to 13.01 mL/kg/min, and patients with severe postoperative complications had lower anaerobic thresholds than those with mild-to-moderate complications.
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