Predictive value of cardiopulmonary exercise test in the postoperative complications in patients with esophageal cancer: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

REN Mengyi ^1,2,3 , LI Jin ^1,3 , ZHANG Ming ^1,2,3 , ZHANG Miao ³ , GAO Min ³ ,  CHEN Wei ^1,2,3

1. The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou, 221010, Jiangsu, P. R. China;
2. Xuzhou Clinical College of Xuzhou Medical University, Xuzhou, 221009, Jiangsu, P. R. China;
3. Xuzhou Central Hospital, Xuzhou, 221009, Jiangsu, P. R. China;

Corresponding author：

CHEN Wei, Email: chenwei2339@163.com

Keywords：

Esophageal cancer; postoperative complications; cardiopulmonary exercise test; lung function

DOI：

10.7507/1007-4848.202211060

Video：

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Objective To explore the predictive value of cardiopulmonary exercise test (CPET) combined with clinical indexes in the postoperative complications. Methods The clinical data and CPET data (including lung function) of patients undergoing radical esophagectomy in Xuzhou Central Hospital from January 2018 to March 2022 were collected. Univariate analysis and multivariate logistic regression analysis were used to analyze the meaningful evaluation index for the occurrence of postoperative complications. Results A total of 77 patients with esophageal cancer were included, including 59 (76.6%) males and 18 (23.4%) females aged 47-80 years. There were 42 (54.5%) patients in the non-complication group and 35 (45.5%) patients in the complication group. Univariate analysis results showed that the occurrence of postoperative complications was significantly correlated with age, body mass index (BMI), smoking index, tumor stage, the length of postoperative hospital stay, peak work rate (WRpeak), peak kilogram oxygen uptake (VO₂peak/kg), the ventilatory equivalent for carbon dioxide slope (VE/VCO₂ slope), forced expiratory volume in the first second/forced vital capacity (FEV1/FVC) and maximum expiratory flow rate (MMEF) (P<0.05). The results of multivariate logistic regression analysis showed that BMI [OR=1.35, 95%CI (1.03, 1.77), P=0.031], peakVO₂/kg [OR=0.64, 95%CI (0.45, 0.93), P=0.018], oxygen uptake-anaerobic threshold (ATVO₂) [OR=0.66, 95%CI (0.44, 0.98), P=0.044] and VE/VCO₂ slope [OR=1.49, 95%CI (1.10, 2.02), P=0.011] were the related indexes of complications after radical resection of esophageal cancer. The sensitivity of BMI, VO₂peak/kg, ATVO₂/kg and VE/VCO₂ slope in predicting postoperative complications was 82.10%, and the specificity was 87.44%, 95%CI (0.744, 0.955). Conclusion BMI, VO₂peak/kg, ATVO₂/kg and VE/VCO₂ slope can be used as predictors for postoperative complications of esophageal cancer.

Citation： REN Mengyi, LI Jin, ZHANG Ming, ZHANG Miao, GAO Min, CHEN Wei. Predictive value of cardiopulmonary exercise test in the postoperative complications in patients with esophageal cancer: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(8): 1148-1155. doi: 10.7507/1007-4848.202211060 Copy

1.	Liu X, Zhou M, Wang F, et al. Secular trend of cancer death and incidence in 29 cancer groups in China, 1990-2017: A joinpoint and age-period-cohort analysis. Cancer Manag Res, 2020, 12: 6221-6238.
2.	Oesophago-Gastric Anastomosis Study Group on behalf of the West Midlands Research Collaborative. Comparison of short-term outcomes from the International Oesophago-Gastric Anastomosis Audit (OGAA), the Esophagectomy Complications Consensus Group (ECCG), and the Dutch Upper Gastrointestinal Cancer Audit (DUCA). BJS Open, 2021, 5(3): zrab010.
3.	Xu QL, Li H, Zhu YJ, et al. The treatments and postoperative complications of esophageal cancer: A review. J Cardiothorac Surg, 2020, 15(1): 163.
4.	Wang J, Zhang B, Meng J, et al. Analysis of risk factors for post-operative complications and prognostic predictors of disease recurrence following definitive treatment of patients with esophageal cancer from two medical centers in Northwest China. Exp Ther Med, 2017, 14(3): 2584-2594.
5.	Older PO, Levett DZH. Cardiopulmonary exercise testing and surgery. Ann Am Thorac Soc, 2017, 14(Supplement_1): S74-S83.
6.	Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 130(24): 2215-2245.
7.	Guazzi M, Arena R, Halle M, et al. 2016 focused update: Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J, 2018, 39(14): 1144-1161.
8.	Lam S, Alexandre L, Hardwick G, et al. The association between preoperative cardiopulmonary exercise-test variables and short-term morbidity after esophagectomy: A hospital-based cohort study. Surgery, 2019, 166(1): 28-33.
9.	宋燕新, 赵威. 心肺运动试验在非心脏手术围手术期的应用. 中华医学杂志, 2019, 99(2): 150-153.
10.	Balady GJ, Arena R, Sietsema K, et al. Clinician's guide to cardiopulmonary exercise testing in adults: A scientific statement from the American Heart Association. Circulation, 2010, 122(2): 191-225.
11.	Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J, 2005, 26(5): 948-968.
12.	Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013, 188(8): e13-e64.
13.	王萌, 王古岩, 孙兴国. 心肺运动试验评估麻醉手术危险性的研究进展. 中国全科医学, 2016, 19(23): 2869-2872.
14.	俞剑昀, 孙兴国, 卢琳, 等. 心肺运动试验 (CPET) 精准预测功能状态良好的肺切除手术患者的术后并发症风险. 中国应用生理学杂志, 2021, 37(2): 195-201.
15.	戚晓通, 陈亦江, 赵胜, 等. 体重指数对食管鳞癌术后并发症的影响. 中国胸心血管外科临床杂志, 2016, 23(11): 1034-1038.
16.	罗越魁, 王成, 孟于琪, 等. 体重指数与食管鳞状细胞癌切除术后转归及总生存率关系的研究. 中国胸心血管外科临床杂志, 2016, 23(5): 467-471.
17.	Kuwano H, Nishimura Y, Oyama T, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus, 2015, 12(1): 1-30.
18.	Mao X, Zhang W, Ni YQ, et al. A prediction model for postoperative pulmonary complication in pulmonary function-impaired patients following lung resection. J Multidiscip Healthc, 2021, 14: 3187-3194.
19.	Patel N, Powell AG, Wheat JR, et al. Cardiopulmonary fitness predicts postoperative major morbidity after esophagectomy for patients with cancer. Physiol Rep, 2019, 7(14): e14174.
20.	Forshaw MJ, Strauss DC, Davies AR, et al. Is cardiopulmonary exercise testing a useful test before esophagectomy? Ann Thorac Surg, 2008, 85(1): 294-299.
21.	Westhoff M, Litterst P, Ewert R. Cardiopulmonary exercise testing in combined pulmonary fibrosis and emphysema. Respiration, 2021, 100(5): 395-403.
22.	Gravier FE, Bonnevie T, Boujibar F, et al. Cardiopulmonary exercise testing in patients with non-small cell lung cancer: Trust the VO2peak? J Thorac Dis, 2020, 12(10): 5313-5323.
23.	Moyes LH, McCaffer CJ, Carter RC, et al. Cardiopulmonary exercise testing as a predictor of complications in oesophagogastric cancer surgery. Ann R Coll Surg Engl, 2013, 95(2): 125-130.
24.	Older P, Hall A. Cardiopulmonary exercise testing in preoperative risk assessment and patient management. Br J Anaesth, 2017, 119(4): 837-838.
25.	Levett DZ, Grocott MP. Cardiopulmonary exercise testing for risk prediction in major abdominal surgery. Anesthesiol Clin, 2015, 33(1): 1-16.
26.	李文婷, 袁平, 吴常伟, 等. 右心房压力联合二氧化碳通气当量斜率预测慢性血栓栓塞性肺动脉高压患者预后的价值研究. 中国循环杂志, 2020, 35(7): 670-676.
27.	Chmelo J, Khaw RA, Sinclair RCF, et al. Does cardiopulmonary testing help predict long-term survival after esophagectomy? Ann Surg Oncol, 2021, 28(12): 7291-7297.
28.	Sinclair RCF, Phillips AW, Navidi M, et al. Pre-operative variables including fitness associated with complications after oesophagectomy. Anaesthesia, 2017, 72(12): 1501-1507.
29.	Torchio R, Mazzucco A, Guglielmo M, et al. Minute ventilation to carbon dioxide output (V'E/V'CO₂ slope) is the strongest death predictor before larger lung resections. Monaldi Arch Chest Dis, 2017, 87(3): 817.

1. Liu X, Zhou M, Wang F, et al. Secular trend of cancer death and incidence in 29 cancer groups in China, 1990-2017: A joinpoint and age-period-cohort analysis. Cancer Manag Res, 2020, 12: 6221-6238.
2. Oesophago-Gastric Anastomosis Study Group on behalf of the West Midlands Research Collaborative. Comparison of short-term outcomes from the International Oesophago-Gastric Anastomosis Audit (OGAA), the Esophagectomy Complications Consensus Group (ECCG), and the Dutch Upper Gastrointestinal Cancer Audit (DUCA). BJS Open, 2021, 5(3): zrab010.
3. Xu QL, Li H, Zhu YJ, et al. The treatments and postoperative complications of esophageal cancer: A review. J Cardiothorac Surg, 2020, 15(1): 163.
4. Wang J, Zhang B, Meng J, et al. Analysis of risk factors for post-operative complications and prognostic predictors of disease recurrence following definitive treatment of patients with esophageal cancer from two medical centers in Northwest China. Exp Ther Med, 2017, 14(3): 2584-2594.
5. Older PO, Levett DZH. Cardiopulmonary exercise testing and surgery. Ann Am Thorac Soc, 2017, 14(Supplement_1): S74-S83.
6. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 130(24): 2215-2245.
7. Guazzi M, Arena R, Halle M, et al. 2016 focused update: Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Eur Heart J, 2018, 39(14): 1144-1161.
8. Lam S, Alexandre L, Hardwick G, et al. The association between preoperative cardiopulmonary exercise-test variables and short-term morbidity after esophagectomy: A hospital-based cohort study. Surgery, 2019, 166(1): 28-33.
9. 宋燕新, 赵威. 心肺运动试验在非心脏手术围手术期的应用. 中华医学杂志, 2019, 99(2): 150-153.
10. Balady GJ, Arena R, Sietsema K, et al. Clinician's guide to cardiopulmonary exercise testing in adults: A scientific statement from the American Heart Association. Circulation, 2010, 122(2): 191-225.
11. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J, 2005, 26(5): 948-968.
12. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med, 2013, 188(8): e13-e64.
13. 王萌, 王古岩, 孙兴国. 心肺运动试验评估麻醉手术危险性的研究进展. 中国全科医学, 2016, 19(23): 2869-2872.
14. 俞剑昀, 孙兴国, 卢琳, 等. 心肺运动试验 (CPET) 精准预测功能状态良好的肺切除手术患者的术后并发症风险. 中国应用生理学杂志, 2021, 37(2): 195-201.
15. 戚晓通, 陈亦江, 赵胜, 等. 体重指数对食管鳞癌术后并发症的影响. 中国胸心血管外科临床杂志, 2016, 23(11): 1034-1038.
16. 罗越魁, 王成, 孟于琪, 等. 体重指数与食管鳞状细胞癌切除术后转归及总生存率关系的研究. 中国胸心血管外科临床杂志, 2016, 23(5): 467-471.
17. Kuwano H, Nishimura Y, Oyama T, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus, 2015, 12(1): 1-30.
18. Mao X, Zhang W, Ni YQ, et al. A prediction model for postoperative pulmonary complication in pulmonary function-impaired patients following lung resection. J Multidiscip Healthc, 2021, 14: 3187-3194.
19. Patel N, Powell AG, Wheat JR, et al. Cardiopulmonary fitness predicts postoperative major morbidity after esophagectomy for patients with cancer. Physiol Rep, 2019, 7(14): e14174.
20. Forshaw MJ, Strauss DC, Davies AR, et al. Is cardiopulmonary exercise testing a useful test before esophagectomy? Ann Thorac Surg, 2008, 85(1): 294-299.
21. Westhoff M, Litterst P, Ewert R. Cardiopulmonary exercise testing in combined pulmonary fibrosis and emphysema. Respiration, 2021, 100(5): 395-403.
22. Gravier FE, Bonnevie T, Boujibar F, et al. Cardiopulmonary exercise testing in patients with non-small cell lung cancer: Trust the VO2peak? J Thorac Dis, 2020, 12(10): 5313-5323.
23. Moyes LH, McCaffer CJ, Carter RC, et al. Cardiopulmonary exercise testing as a predictor of complications in oesophagogastric cancer surgery. Ann R Coll Surg Engl, 2013, 95(2): 125-130.
24. Older P, Hall A. Cardiopulmonary exercise testing in preoperative risk assessment and patient management. Br J Anaesth, 2017, 119(4): 837-838.
25. Levett DZ, Grocott MP. Cardiopulmonary exercise testing for risk prediction in major abdominal surgery. Anesthesiol Clin, 2015, 33(1): 1-16.
26. 李文婷, 袁平, 吴常伟, 等. 右心房压力联合二氧化碳通气当量斜率预测慢性血栓栓塞性肺动脉高压患者预后的价值研究. 中国循环杂志, 2020, 35(7): 670-676.
27. Chmelo J, Khaw RA, Sinclair RCF, et al. Does cardiopulmonary testing help predict long-term survival after esophagectomy? Ann Surg Oncol, 2021, 28(12): 7291-7297.
28. Sinclair RCF, Phillips AW, Navidi M, et al. Pre-operative variables including fitness associated with complications after oesophagectomy. Anaesthesia, 2017, 72(12): 1501-1507.
29. Torchio R, Mazzucco A, Guglielmo M, et al. Minute ventilation to carbon dioxide output (V'E/V'CO₂ slope) is the strongest death predictor before larger lung resections. Monaldi Arch Chest Dis, 2017, 87(3): 817.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Predictive value of cardiopulmonary exercise test in the postoperative complications in patients with esophageal cancer: A retrospective cohort study

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