Poor performance in incremental shuttle walk and cardiopulmonary exercise testing predicts poor overall survival for patients undergoing esophago-gastric resection

Whibley, Jessica; Peters, Christopher J.; Halliday, Laura; Chaudry, Asif; Allum, William

doi:10.1016/j.ejso.2018.01.242

Cited by 29 publications

(24 citation statements)

References 22 publications

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“…Cardiopulmonary exercise testing (CPET) provides an integrated assessment of the body's response to stress and is a reliable tool to stratify patients at risk of major complications after elective surgery [31,32]. Few studies have evaluated the role of CPET in patients undergoing esophagectomy and the results have been inconclusive [33][34][35][36][37]. Further research is needed to establish the role of CPET as a preoperative assessment tool for patients undergoing esophagectomy.…”

Section: Cardiopulmonary Assessmentmentioning

confidence: 99%

“…Further research is needed to establish the role of CPET as a preoperative assessment tool for patients undergoing esophagectomy. Sub-optimal tests like the 6-min walk test and the shuttle walk test have been used as substitutes for a formal cardiopulmonary exercise test, but there are limited data to validate their role in the risk stratification of patients undergoing esophagectomy [34][35][36]. In our practice, only patients with significant cardiopulmonary risk factors are subjected to a CPET.…”

Section: Cardiopulmonary Assessmentmentioning

confidence: 99%

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The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection

et al. 2020

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Esophageal cancer surgery, comprising esophagectomy with radical lymphadenectomy, is a complex procedure associated with considerable morbidity and mortality. The enhanced recovery after surgery (ERAS) protocol which aims to improve perioperative care, minimize complications, and accelerate recovery is showing promise for achieving better perioperative outcomes. ERAS is a multimodal approach that has been reported to shorten the length of hospital stay, reduce surgical stress response, decrease morbidity, and expedite recovery. While ERAS components straddle preoperative, intraoperative, and postoperative periods, they need to be seen in continuum and not as isolated elements. In this review, we elaborate on the components of an ERAS protocol after esophagectomy including preoperative nutrition, prehabilitation, counselling, smoking and alcohol cessation, cardiopulmonary evaluation, surgical technique, anaesthetic management, intra-and postoperative fluid management and pain relief, mobilization and physiotherapy, enteral and oral feeding, removal of drains, and several other components. We also share our own institutional protocol for ERAS following esophageal resections.

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Section: Cardiopulmonary Assessmentmentioning

confidence: 99%

Section: Cardiopulmonary Assessmentmentioning

confidence: 99%

The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection

et al. 2020

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“…12 studies used an age threshold for gating access to CPET, in seven of these a lower age threshold was used if the individual suffered from specific comorbidities (normally cardiovascular or diabetes). In five cases [27][28][29][30][31] we felt it was impossible to determine, due to phrasing of the papers or study design, exactly who was selected to undergo CPET and whether eligible participants might have been missed. In one study the inclusion criteria changed throughout the inclusion period from being selected on the basis of comorbidity to being consecutive.…”

Section: Study Characteristicsmentioning

confidence: 99%

Performance of cardiopulmonary exercise testing for the prediction of post-operative complications in non cardiopulmonary surgery: A systematic review

2020

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Introduction Cardiopulmonary exercise testing (CPET) is widely used within the United Kingdom for preoperative risk stratification. Despite this, CPET's performance in predicting adverse events has not been systematically evaluated within the framework of classifier performance. Methods After prospective registration on PROSPERO (CRD42018095508) we systematically identified studies where CPET was used to aid in the prognostication of mortality, cardiorespiratory complications, and unplanned intensive care unit (ICU) admission in individuals undergoing non-cardiopulmonary surgery. For all included studies we extracted or calculated measures of predictive performance whilst identifying and critiquing predictive models encompassing CPET derived variables. Results We identified 36 studies for qualitative review, from 27 of which measures of classifier performance could be calculated. We found studies to be highly heterogeneous in methodology and quality with high potential for bias and confounding. We found seven studies that presented risk prediction models for outcomes of interest. Of these, only four studies outlined a clear process of model development; assessment of discrimination and calibration were performed in only two and only one study undertook internal validation. No scores were externally validated. Systematically identified and calculated measures of test performance for CPET demonstrated mixed performance. Data was most complete for anaerobic threshold (AT) based predictions: calculated sensitivities ranged from 20-100% when used for predicting risk of mortality with high negative predictive values (96-100%). In contrast, positive predictive value (PPV) was poor (2.9-42.1%). PPV appeared to be generally higher for cardiorespiratory complications, with similar sensitivities. Similar patterns were seen for the PLOS ONE |

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“…We wish to acknowledge the contributions of Wendy Hickey 1 , Claire Coleman 1 , Louise Buckley 5 , Eileen Lombard 5 , Noel McCaffrey 3 , Pamela Gallagher 6 , Claire Timon 7 , Patricia Kearney 8 , Aoife Quinn 4 , Emma Houlihan 9 ,…”

Section: Acknowledgmentsmentioning

confidence: 99%

The effect of a pre- and post-operative exercise programme versus standard care on physical fitness of patients with oesophageal and gastric cancer undergoing neoadjuvant treatment prior to surgery (The PERIOP-OG Trial): Study protocol for a randomised controlled trial

Tully

Loughney

Bolger

et al. 2020

Trials

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Background: Advances in peri-operative oncological treatment, surgery and peri-operative care have improved survival for patients with oesophagogastric cancers. Neoadjuvant cancer treatment (NCT) reduces physical fitness, which may reduce both compliance and tolerance of NCT as well as compromising post-operative outcomes. This is particularly detrimental in a patient group where malnutrition is common and surgery is demanding. The aim of this trial is to assess the effect on physical fitness and clinical outcomes of a comprehensive exercise training programme in patients undergoing NCT and surgical resection for oesophagogastric malignancies.

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Poor performance in incremental shuttle walk and cardiopulmonary exercise testing predicts poor overall survival for patients undergoing esophago-gastric resection

Abstract: ISWT and CPET can be useful preoperative tools to predict overall survival for patients undergoing esophago-gastric resection. Furthermore, patients that improve their functional status during chemotherapy seem to do better than those where it remains static or declines.

Cited by 29 publications

References 22 publications

The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection

The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection

Performance of cardiopulmonary exercise testing for the prediction of post-operative complications in non cardiopulmonary surgery: A systematic review

The effect of a pre- and post-operative exercise programme versus standard care on physical fitness of patients with oesophageal and gastric cancer undergoing neoadjuvant treatment prior to surgery (The PERIOP-OG Trial): Study protocol for a randomised controlled trial

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