Exercise capacity in the stair-climbing test predicts outcomes of operable esophageal cancer in minimally invasive era

Junttila, Anna; Helminen, Olli; Mrena, Johanna; Sihvo, Eero

doi:10.1016/j.ejso.2021.10.024

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…Third, several of these variables, including VE/VCO 2 slope is measured at submaximal effort and thus does not require a truly maximal test. Future studies should focus on which patients that can be assessed by screening with a more widely available functional test, and which patients benefit from the more comprehensive CPET (Junttila et al., 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Peak oxygen uptake in combination with ventilatory efficiency improve risk stratification in major abdominal surgery

Kristenson,

Gerring,

Björnsson

et al. 2024

Physiological Reports

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This pilot study aimed to evaluate if peak VO2 and ventilatory efficiency in combination would improve preoperative risk stratification beyond only relying on peak VO2. This was a single‐center retrospective cohort study including all patients who underwent cardiopulmonary exercise testing (CPET) as part of preoperative risk evaluation before major upper abdominal surgery during years 2008–2021. The primary outcome was any major cardiopulmonary complication during hospitalization. Forty‐nine patients had a preoperative CPET before decision to pursue to surgery (cancer in esophagus [n = 18], stomach [6], pancreas [16], or liver [9]). Twenty‐five were selected for operation. Patients who suffered any major cardiopulmonary complication had lower ventilatory efficiency (i.e., higher VE/VCO2 slope, 37.3 vs. 29.7, p = 0.031) compared to those without complications. In patients with a low aerobic capacity (i.e., peak VO2 < 20 mL/kg/min) and a VE/VCO2 slope ≥ 39, 80% developed a major cardiopulmonary complication. In this pilot study of patients with preoperative CPET before major upper abdominal surgery, patients who experienced a major cardiopulmonary complication had significantly lower ventilatory efficiency compared to those who did not. A low aerobic capacity in combination with low ventilatory efficiency was associated with a very high risk (80%) of having a major cardiopulmonary complication.

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Section: Discussionmentioning

confidence: 99%

Peak oxygen uptake in combination with ventilatory efficiency improve risk stratification in major abdominal surgery

Kristenson,

Gerring,

Björnsson

et al. 2024

Physiological Reports

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“…From a research perspective, the current study indicates a need for studies examining factors influencing survival for different age groups, including the utility of objective assessment of fitness (e.g., exercise tests, stair-climbing tests, and spirometry). 23 Such research may guide a more precise evaluation of the potential benefits and harm that surgery may bring to different age groups.…”

Section: Discussionmentioning

confidence: 99%

Impact of Age on the Treatment and Survival in Esophagogastric Cancer

2023

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Background The age-specific risks of mortality for patients with esophagogastric cancer and their probability of surgical treatment are not well-known. Methods This population-based, nationwide cohort study included all patients with esophageal or gastric (esophagogastric) cancer in Sweden between 1990 and 2013, with follow-up evaluation throughout 2018. Age at diagnosis (exposure) was categorized into nine 5-year groups. The main outcome was 5-year all-cause mortality. The secondary outcomes were 90-day all-cause mortality, 5-year disease-specific mortality, 5-year disease-specific mortality excluding 90-day all-cause mortality, and non-operation. For mortality outcomes, Cox regression provided hazard ratios (HRs) with 95% confidence intervals (95% CIs) adjusted for confounders. For non-operation, logistic regression provided odds ratios (ORs) with 95% CIs. Results Among 28,725 patients, 11,207 (39.0%) underwent surgery. For those who underwent surgery, the HRs of 5-year all-cause mortality were stable before the ages of 65 to 69 years. After that, it gradually increased for patients 65 to 69 years old (HR, 1.13; 95% CI, 1.01–1.26), patients 75 to 79 years old (HR, 1.29; 95% CI, 1.56–1.44), and patients older than 85 years (HR, 1.84; 95% CI, 1.60–2.11) compared with those younger than 50 years. Analyses of age as a continuous variable, other mortality outcomes and stratification by comorbidity and tumor type showed similar results. The odds of non-operation increased for patients 75 to 79 years old (OR, 2.09 [95% CI, 1.84–2.94] for patients 80 to 84 years old and OR, 5.00 [95% CI, 4.31–5.78] for patients ≥85 years old or older), compared with those younger than 50 years. Conclusion Older age, starting from 65 years, is associated with worse survival after surgery for esophagogastric cancer, and from 75 years with lower odds of surgical treatment.

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“…Both the main analysis and multiple subgroup analyses showed significantly worse 5-year survival in the stent group. Still residual confounding is possible, since patient-related factors such as physical fitness 22 and muscle loss 23 could not be adjusted for. Also, although BMI was adjusted, a more important factor of the decrease in BMI could not be adjusted.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Esophageal Stenting and 5-Year Survival in Patients Undergoing Esophagectomy for Esophageal Cancer: a Population-Based Nationwide Study from Finland

Helminen

Sihvo

Helmiö

et al. 2023

Journal of Gastrointestinal Surgery

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Background Preoperative esophageal stenting is proposed to have a negative effect on outcomes. The aim was to compare a 5-year survival in patients undergoing esophagectomy for esophageal cancer with and without preoperative esophageal stent in a population-based nationwide cohort from Finland. The secondary outcome was 90-day mortality. Methods This study included curatively intended esophagectomies for esophageal cancer in Finland between 1999 and 2016, with follow-up until December 31, 2019. Cox proportional hazards models provided hazard ratios (HRs) with 95% confidence intervals (CIs) of overall 5-year and 90-day mortality. Model 1 was adjusted for age, sex, year of the surgery, comorbidities, histology, pathological stage, and neoadjuvant therapy. Model 2 included also albumin level and BMI. Result Of 1064 patients, a total of 134 patients underwent preoperative stenting and 930 did not. In both adjusted models 1 and 2, higher 5-year mortality was seen in patients with preoperative stent with HRs of 1.29 (95% CI 1.00–1.65) and 1.25 (95% CI 0.97–1.62), respectively, compared to no stenting. The adjusted HR of 90-day mortality was 2.49 (95% CI 1.27–4.87) in model 1 and 2.49 (95% CI 1.25–4.99) in model 2. When including only neoadjuvant-treated patients, those with preoperative stent had a 5-year survival of 39.2% compared to 46.4% without stent (adjusted HR 1.34, 95% CI 1.00–1.80), and a 90-day mortality rate of 8.5% and 2.5% (adjusted HR 3.99, 95% CI 1.51–10.50). Discussion This nationwide study reports worse 5-year and 90-day outcomes in patients with preoperative esophageal stent. Since residual confounding remains possible, observed difference could be only an association rather than the cause.

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Exercise capacity in the stair-climbing test predicts outcomes of operable esophageal cancer in minimally invasive era

Cited by 6 publications

References 31 publications

Peak oxygen uptake in combination with ventilatory efficiency improve risk stratification in major abdominal surgery

Peak oxygen uptake in combination with ventilatory efficiency improve risk stratification in major abdominal surgery

Impact of Age on the Treatment and Survival in Esophagogastric Cancer

Preoperative Esophageal Stenting and 5-Year Survival in Patients Undergoing Esophagectomy for Esophageal Cancer: a Population-Based Nationwide Study from Finland

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