Key result
A preoperative VO2 peak greater than 15 mL/kg/min was associated with significantly decreased odds of postoperative mortality (OR 0.55) in patients undergoing lung resection for lung cancer.
Why the study?
Cardiopulmonary exercise testing is the gold standard to assess exercise capacity before lung resection for lung cancer, but associations between preoperative testing and postoperative outcomes required systematic investigation.
Do preoperative cardiopulmonary exercise testing (CPET) parameters predict postoperative mortality and morbidity in patients undergoing lung resection surgery for lung cancer?
Systematic Review (n=6,450)
Do preoperative cardiopulmonary exercise testing (CPET) parameters predict postoperative mortality and morbidity in patients undergoing lung resection surgery for lung cancer?
Odds Ratio: 0.55 (95% CI 0.28–0.81)
Preoperative CPET, specifically higher VO2 peak, is a significant predictor of reduced postoperative mortality and morbidity in patients undergoing lung resection for lung cancer.
May inform preoperative risk stratification before lung resection; confirms VO2 peak as prognostic marker but needs prospective validation.
BACKGROUND: Exercise capacity should be determined in all patients undergoing lung resection for lung cancer surgery and cardiopulmonary exercise testing (CPET) remains the gold standard. The purpose of this study was to investigate associations between preoperative CPET and postoperative outcomes in patients undergoing lung resection surgery for lung cancer through a review of the existing literature. METHODS: A search was conducted on PubMed, Scopus, Cochrane Library and CINAHL from inception until December 2022. Studies investigating associations between preoperative CPET and postoperative outcomes were included. Risk of bias was assessed using the QUIPS tool. A random effect model meta-analysis was performed. I2 > 40% indicated a high level of heterogeneity. RESULTS: Thirty-seven studies were included with 6450 patients. Twenty-eight studies had low risk of bias. [Formula: see text] peak is the oxygen consumption at peak exercise and serves as a marker of cardiopulmonary fitness. Higher estimates of [Formula: see text] peak, measured and as a percentagege of predicted, showed significant associations with a lower risk of mortality [MD: 3.66, 95% CI: 0.88; 6.43 and MD: 16.49, 95% CI: 6.92; 26.07] and fewer complications [MD: 2.06, 95% CI: 1.12; 3.00 and MD: 9.82, 95% CI: 5.88; 13.76]. Using a previously defined cutoff value of > 15mL/kg/min for [Formula: see text] peak, showed evidence of decreased odds of mortality [OR: 0.55, 95% CI: 0.28-0.81] and but not decreased odds of postoperative morbidity [OR: 0.82, 95% CI: 0.64-1.00]. There was no relationship between [Formula: see text] slope, which depicts ventilatory efficiency, with mortality [MD: -9.60, 95% CI: -27.74; 8.54] however, patients without postoperative complications had a lower preoperative [Formula: see text] [MD: -2.36, 95% CI: -3.01; -1.71]. Exercise load and anaerobic threshold did not correlate with morbidity or mortality. There was significant heterogeneity between studies. CONCLUSIONS: Estimates of cardiopulmonary fitness as evidenced by higher [Formula: see text] peak, measured and as a percentage of predicted, were associated with decreased morbidity and mortality. A cutoff value of [Formula: see text] peak > 15mL/kg/min was consistent with improved survival but not with fewer complications. Ventilatory efficiency was associated with decreased postoperative morbidity but not with improved survival. The heterogeneity in literature could be remedied with large scale, prospective, blinded, standardised research to improve preoperative risk stratification in patients with lung cancer scheduled for lung resection surgery.
No takes yet. Share an insight, caveat, or question.
Arbee-Kalidas et al. (2023) conducted a systematic review in Lung cancer undergoing lung resection surgery (n=6,450). Preoperative VO2 peak > 15 mL/kg/min vs. Preoperative VO2 peak ≤ 15 mL/kg/min was evaluated on Postoperative mortality (OR 0.55, 95% CI 0.28-0.81). A preoperative VO2 peak greater than 15 mL/kg/min was associated with significantly decreased odds of postoperative mortality (OR 0.55) in patients undergoing lung resection for lung cancer.