Exercise capacity and extent of resection as predictors of surgical risk in lung cancer

Abstract

Lung resection remains the most effective treatment for non-small cell lung cancer (NSCLC). However, there is no consensus about reliable operative risk assessment in these patients. The aim of this study was to identify predictors of postoperative complications and death after lung resection for NSCLC.In this prospective trial, 125 of 142 (88%) consecutive NSCLC patients from 1990 to August 1997 had complete data sets. All underwent functional assessment including spirometry and cardiopulmonary exercise tests and lung resection via thoracotomy.Complications occurred in 31 of 125 (25%) patients including 2 (1.6%) deaths. On logistic regression analysis, only maximal oxygen uptake (V 'O 2 ,max) . kg body weight -1 expressed as a percentage of the predicted value (p<0.0001) and the estimated extent of lung tissue resection (p=0.02) were independent predictors of postoperative complications. Six of seven patients with a V 'O 2 ,max . kg body weight -1 of <60% pred, but only eight of 65 with values >90% pred, exhibited postoperative complications.Maximal oxygen uptake and the estimated extent of lung tissue resection are independent predictors of postoperative complications. These simple parameters should be integrated into the preoperative decision analysis for operability in patients undergoing lung resection for lung cancer. Eur Respir J 2000; 15: 828±832.

Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery

“…In agreement with previous reports, we confirmed that a peak V9O 2 .20 mL?kg -1 ?min -1 is a safe cut-off value for lung resection since no mortality and ,8% respiratory and cardiac complications occurred above this threshold [13,23,24,25]. In contrast, below 10 mL?kg -1 ?min -1 peak V9O 2 , patients experienced a fourfold higher incidence of cardiovascular and pulmonary complications, compared with surgical candidates presenting peak V9O 2 values .20 mL?kg…”

Minute ventilation to carbon dioxide output (V’E/V’CO2 slope) is the strongest death predictor before larger lung resections

“…The use of exercise testing in the preoperative evaluation of patients with impaired lung mechanics and gas exchange is safe and simple and the V' O2peak was the first exercise testing variable recognized as prognostic in many clinical situations, from the preoperative evaluation before lung resection [1,4], to CHF patients' management [14][15][16][17]. Moreover, between cardiopulmonary exercise test parameters, the V' E /V' CO2 slope measurement had clinical relevance in patients with pulmonary congestion and heart failure [18,19] and was recognized as a marker of pulmonary hypertension in COPD patients [20].…”

“…According to the Literature, major cardiopulmonary morbidity occurred if one or more than one of the following were present: cardiac failure requiring inotropic support other than renal dose dopamine; hemodinamically unstable arrhythmia requiring treatment; pulmonary embolism diagnosed by high probability perfusion scan or helical computed tomographic scan; respiratory failure (partial arterial oxygen pressure (P a O 2 ) <65 mm Hg and/or partial arterial carbon dioxide pressure (P a CO 2 ) >45 mmHg) requiring non-invasive or invasive mechanical ventilation; pneumonia defined by typical clinical, laboratory, and radiographic features; atelectasis requiring bronchoscopy and/or noninvasive assisted ventilation [4,6].…”

“…The assessment of the lower limit of surgical tolerance for lung resection in patients with non-small-cell lung cancer (NSCLC) remains difficult [1][2][3][4][5][6]. Although peak oxygen consumption (V' O2peak ) is the most used variable in the preoperative evaluation before lung resection, recently the ventilatory inefficiency (measured as the minute ventilation to CO 2 production ratio (V' E /V' CO2 slope) was considered as useful [7], or even the best [8] survival predictor after lung resection.…”

Prediction of Postoperative Lung Function

“…Cardiopulmonary exercise testing has been used as a means to access a patient's fitness for lung resection. Several studies have identified exercise capacity (VO2max) as a predictor of postoperative complications as well as of postoperative long term mortality Brutsche, et al 2000). Risk for perioperative complications can generally be stratified by VO2max.…”