BackgroundThis pilot study compared the risk predictive value of preoperative physiological capacity (PC: defined by gas exchange measured during cardiopulmonary exercise testing) with the ASA physical status classification in the same patients (n=32) undergoing major abdominal cancer surgery.MethodsUni- and multivariate logistic regression models were fitted to measurements of PC and ASA rank data determining their predictive value for postoperative morbidity. Receiver operating characteristic (ROC) curves were used to discriminate between the predictive abilities, exploring trade-offs between sensitivity and specificity.ResultsIndividual statistically significant predictors of postoperative morbidity included the ASA rank [P=0.038, area under the curve (AUC)=0.688, sensitivity=0.630, specificity=0.750] and three newly identified measures of PC: PAT (% predicted anaerobic threshold achieved, <75% vs ≥75%), ΔHR1 (heart rate response from rest to the anaerobic threshold), and HR3 (heart rate at the anaerobic threshold). A two-variable model of PC measurements (ΔHR1+PAT) was also shown to be statistically significant in the prediction of postoperative morbidity (P=0.023, AUC=0.826, sensitivity=0.813, specificity=0.688).ConclusionsThree newly identified PC measures and the ASA rank were significantly associated with postoperative morbidity; none showed a statistically greater association compared with the others. PC appeared to improve predictive sensitivity. The potential for new unidentified measures of PC to predict postoperative outcomes remains unexplored.

Objectives-Patients undergoing cystectomy often have significant baseline cardiac disease. Despite pre-operative medical optimization, post-operative cardiac complications remain a significant source of morbidity. We sought to evaluate risk factors for post-cystectomy cardiac complications (POCC).Methods-A retrospective review of all radical cystectomies for bladder cancer from 1/2004 through 9/2006 was performed. Twelve pre-operative risk factors were evaluated including age, Charleson Co-morbidity index, type of urinary diversion, and prior cardiac history. All complications were recorded for 90 days post-operatively including myocardial infarction (MI) and new onset arrhythmia (NOA). Univariate and multivariate analysis were performed.Results-283 patients underwent cystectomy for bladder cancer from 1/2004 to 9/2006. The median age of the cohort was 70 (35-90). 64 pts (23%) had a significant pre-operative cardiac history, including 18 (6%) with prior coronary artery bypass and 30 (11%) with a history of MI's. Thirtyone (11%) patients had either NOA (22, 8%) or MI (10, 4%); one had both. On univariate analysis, cardiac history, age, type of urinary diversion, and the Charleson co-morbidity index demonstrated significance. The risk of POCC was associated with ileal conduit urinary diversion (p=0. 026,) and the Charleson Index score (p=0.030, OR 1.28 [1.024-1.60]) on multivariate analysis.Conclusions-Multiple, inter-related factors may predict cardiac complications in the early postoperative period. Despite peri-operative optimization, patients with a prior cardiac history should be counseled regarding the increased risk of postoperative cardiac complications. The association between cardiac complications and ileal conduit diversion highlights the selection bias towards patients with pre-existing co-morbid disease.

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e15589 Background: Recent treatment trends for resectable esophageal cancer have moved toward the addition of neoadjuvant chemoradiotherapy. This additional therapy, however, places these patients at increased risk for loss of physiologic/functional capacity. If present, such declines can delay resection of the primary tumor until the patient has physiologically recovered from this insult. To determine whether physiological reserves decline, peak exercise performance was assessed before and after completing neoadjuvant therapy Methods: In this prospective study seventeen male patients (60.5 + 7.1 years) with esophageal cancers underwent a symptom limited, standard ramp bicycle ergometer cardiopulmonary exercise test (CPET) before and after completing neoadjuvant therapy. The exercise protocol sequentially entailed 3 minutes of quiet resting, 3 minutes of unloaded cycling, ramp protocol to peak exercise tolerance, and 3 minutes of recovery. Ramp rates (5–25 watts/.min) were individually chosen to achieve test durations of 8–12 minutes. Expired gases were measured for volume and gas fractions via breath-by-breath analysis (Medical Graphics CardiO2/CP system). STATISTICAL ANALYSIS: Physiological data were analyzed by paired t-tests (α=0.05). Data are presented as mean + standard deviation. Results: Pre treatment exercise testing occurred immediately before onset of treatment. Post treatment exercise testing typically occurred 45 + 17 days after neoadjuvant ended and 11 + 10 days before surgery. Peak exercise capacity (VO2peak) and anaerobic threshold declined 11.9 % and 10.5 % respectively (p < 0.01) over the neoadjuvant therapy treatment period. Both oxygen pulse (VO2/HR) and pulse pressure product (HR X SP) at VO2peak also significantly declined (p< 0.01) over the treatment period. Conclusions: These results suggest 1) both systemic and peripheral changes contribute to an overall physiological and functional decline in patients undergoing neoadjuvant therapy and 2) efforts aimed at preserving optimal physiological/functional capacity may be warranted during this period. No significant financial relationships to disclose.

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