Cardiopulmonary Exercise Testing for Preoperative Risk Assessment before Pancreaticoduodenectomy for Cancer

Junejo, Muneer; Mason, James; Sheen, Aali J.; Bryan, Angela; Moore, J. A.; Foster, Paul J.; Atkinson, D.; Parker, Michael; Siriwardena, Ajith K.

doi:10.1245/s10434-014-3493-0

Cited by 57 publications

(52 citation statements)

References 20 publications

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“…AT represents the upper limit of workload beyond which prolonged exercise is impossible (28). It has been shown to be an objective marker of CVR (19)(20)(21)(22)28). Patients undergoing EVAR have a high-prevalence of AKI risk-factors and are at significant risk of AKI (1,14).…”

Section: Discussionmentioning

confidence: 99%

“…Cardiovascular reserve (CVR) is a parameter that is modifiable through various interventions before non-urgent surgery. Estimation of CVR is increasingly being used to identify those at highest risk of complications after surgery (19)(20)(21)(22).…”

Section: Introductionmentioning

confidence: 99%

“…The corresponding VO2 at which circulating lactate begins to rise defines the point of Anaerobic Threshold (AT), which can be measured by Cardiopulmonary Exercise Testing (CPET). The latter (CPET) is now being used frequently prior to major surgery (20)(21)(22)(23)(24). It provides an accurate estimate of CVR by measuring AT, a validated objective and reproducible marker of CVR, independent patient effort (25)(26)(27)(28)(29).…”

Section: Introductionmentioning

confidence: 99%

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Pre-operative Functional Cardiovascular Reserve Is Associated with Acute Kidney Injury after Intervention

Saratzis

Shakespeare

Jones

et al. 2017

European Journal of Vascular and Endovascular Surgery

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What this paper addsThe impact of cardiovascular reserve on acute kidney injury (AKI) after endovascular surgery remains unclear, mostly due to the difficulties in assessing cardiovascular reserve. We are still unsure whether AKI is related mostly to pre-existing occult co-morbidities, such as cardiovascular disease, or procedure-related parameters. Hence, developing an adequate renoprotective strategy is not an easy task. In this analysis, we have shown that development of AKI after intervention is associated with pre-operative cardiovascular reserve, independent of other risk-factors and procedural parameters. This offers insight in what drives AKI development after endovascular intervention and where/how preventative measures should focus.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pre-operative Functional Cardiovascular Reserve Is Associated with Acute Kidney Injury after Intervention

Saratzis

Shakespeare

Jones

et al. 2017

European Journal of Vascular and Endovascular Surgery

View full text Add to dashboard Cite

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“…Cardiopulmonary exercise testing that measures oxygen consumption and carbon dioxide elimination may identify a subgroup of patients with increased operative risk but mortality is low, so the use of the test as a discriminatory factor is not fully adequate [45].…”

Section: Operability Assessmentmentioning

confidence: 99%

Pancreatic Cancer: Yesterday, Today and Tomorrow

et al. 2016

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Pancreatic cancer is one of our most lethal malignancies. Despite substantial improvements in the survival rates for other major cancer forms, pancreatic cancer survival rates have remained relatively unchanged since the 1960s. Pancreatic cancer is usually detected at an advanced stage and most treatment regimens are ineffective, contributing to the poor overall prognosis. Herein, we review the current understanding of pancreatic cancer, focusing on central aspects of disease management from radiology, surgery and pathology to oncology. Historical remarks & present stateThe first known description of pancreatic cancer is attributed to Giovanni Battista Morgagni in his 1761 publication 'de Sedibus Et Causis Morborum Per Anatomen Indagatis Libri Quinque' [1]. However, the lack of a microscopic evaluation makes the true diagnosis of ductal adenocarcinoma uncertain. The next important advancement in our understanding of pancreatic cancer did not come until 1858, when Jacob Mendez Da Costa revisited Morgagni's original work and also described the first microscopic diagnosis of adenocarcinoma, manifesting pancreatic cancer as a true disease entity [2].The history of pancreatic surgery is fairly recent and involves a combination of brave surgical pioneers, the development of surgical anesthesia and modern aseptic techniques. Some landmarks in the history of pancreatic surgery deserve to be mentioned. The first reported attempt at a pancreaticoduodenectomy was performed in 1898 by the Italian surgeon Alessandro Codivilla for a tumor involving the head of the pancreas [3]; however, the patient did not survive the postoperative period. In the same year, William Stewart Halsted from Johns Hopkins Hospital performed the first successful resection for ampullary cancer by excising portions of the duodenum and the pancreas [4]. The first successful pancreaticoduodenectomy is credited to the German surgeon Walther Carl Eduard Kausch, as part of a two-stage procedure [5]. In 1914, Georg Hirschel performed the first successful pancreaticoduodenectomy in one stage [6] and then in 1935, Allen Oldfather Whipple presented the results of a two-stage procedure involving the resection of the head of the pancreas and duodenum for ampullary carcinoma at the annual meeting of the American Surgical Association, which renewed interest in pancreatic surgery [7]. During his career, Whipple performed 37 pancreaticoduodenectomies, with the procedure evolving into a one-stage technique [8,9], and 1964-1968 1969-1973 1974-1978 1979-1983 1984-1988 1989-1993 1994-1998 1999-2003 2004-2008 2009-2013 Period of diagnosis Whipple is generally credited with popularizing the operation that still bears his name. In 1937, Alexander Brunschwig performed the first successful pancreaticoduodenectomy for pancreatic adenocarcinoma [10]. Today, with the concentration of experience in high-volume hospitals, pancreatic surgery has become a safe procedure associated with an operative mortality below 3% [11][12][13]. While major advances have been made ...

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“…19,39 In practical terms, this degree of variability is potentially significant when considering outcomes in perioperative assessments. 5,11,13,15,22,[39][40][41] In two recent reviews, Levett et al 5,12 summarized studies assessing the association between preoperative VT and postoperative outcomes. These studies among different surgery candidates (including major intra-abdominal, colon, rectal, hepatobiliary, hepatic resection, liver transplant, upper gastrointestinal, bariatric, cystectomy, and AAA repair procedures) showed that values below 9-12 mLO 2 Ákg -1…”

Section: Discussionmentioning

confidence: 99%

Comparaison des méthodes de détermination des seuils ventilatoires: implications pour la stratification du risque chirurgical

Vainshelboim

Rao

Chan

et al. 2017

Can J Anesth/J Can Anesth

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Purpose The ventilatory threshold (VT) is an objective physiological marker of the capacity of aerobic endurance that has good prognostic applications in preoperative settings. Nevertheless, determining the VT can be challenging due to physiological and methodological issues, especially in evaluating surgical risk. The purpose of the current study was to compare different methods of determining VT and to highlight the implications for assessing perioperative risk. Methods Our study entailed analysis of 445 treadmill cardiopulmonary exercise tests from 140 presurgical candidates with an aortic abdominal aneurysm (C3.0 to B5.0 cm) and a mean (standard deviation [SD]) age of 72 (8) yr. We used three methods to determine the VT in 328 comparable tests, namely, self-detected metabolic system (MS), experts' visual (V) readings, and software using a log-log transformation (LLT) of ventilation vs oxygen uptake. Differences and agreement between the three methods were assessed using analysis of variance (ANOVA), coefficient of variation (CV), typical error limits of agreement (LoA), and interclass correlation coefficients (ICC).Results Overall, ANOVA revealed significant differences between the methods [MS = 14.1 (4.3) mLO 2 Ákg -1 Ámin-1 ; V = 14.6 (4.4) mLO 2 Ákg -1 Ámin -1 ; and LLT = 12.3 (3.3) mLO 2 Ákg -1 Ámin -1 ; P \ 0.001]. The assessment of agreement between methods provided the following results: ICC = 0.85; 95% confidence interval (CI), 0.82 to 0.87; P \ 0.001; typical error, 2.1-2.8 mLO 2 Ákg -1 Ámin -1 ; and, 95% LoA and CV ranged from 43 to 55% and 15.9 to 19.6%, respectively. Conclusions The results show clinically significant variations between the methods and underscore the challenges of determining VT for perioperative risk stratification. The findings highlight the importance of meticulous evaluation of VT for predicting surgical outcomes. Future studies should address the prognostic perioperative utility of computed mathematical models combined with an expert's review. This trial was registered at ClinicalTrials.gov, identifier: NCT00349947.

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Cardiopulmonary Exercise Testing for Preoperative Risk Assessment before Pancreaticoduodenectomy for Cancer

Cited by 57 publications

References 20 publications

Pre-operative Functional Cardiovascular Reserve Is Associated with Acute Kidney Injury after Intervention

Pre-operative Functional Cardiovascular Reserve Is Associated with Acute Kidney Injury after Intervention

Pancreatic Cancer: Yesterday, Today and Tomorrow

Comparaison des méthodes de détermination des seuils ventilatoires: implications pour la stratification du risque chirurgical

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