Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus.
OBJECTIVE
We evaluated the usefulness of analyzing expired gas during exercise testing for the prediction of postoperative cardiopulmonary complications in patients with esophageal carcinoma.


BACKGROUND
Radical esophagectomy with 3-field lymphadenectomy is performed in patients with thoracic esophageal carcinoma but has a high risk of postoperative complications. To reduce the surgical risk, we performed preoperative risk analysis using 8 factors. Although hospital mortality was decreased when this risk analysis was used, severe cardiopulmonary complications still occurred.


METHODS
The study group consisted of 91 patients who had undergone curative esophagectomy with 3-field lymphadenectomy. The maximum oxygen uptake, anaerobic threshold, vital capacity, percent vital capacity, forced expiratory volume in 1 second, percent forced expiratory volume, V.(25)/HT, forced expired flow at 75% of forced vital capacity to height ratio (FEF(75%)/HT), forced expired flow at 50% to 75% of forced vital capacity ratio (FEF(50%)/FEF(75%)), percent diffusion capacity for carbon monoxide, and arterial oxygen tension were measured. Patients were divided into 2 groups on the basis of the presence or absence of postoperative cardiopulmonary complications.


RESULTS
Only the maximum oxygen uptake was significantly different between the 2 groups. All patients were grouped according to the value of the maximum oxygen uptake, and the occurrence of postoperative cardiopulmonary complications was calculated for each group. A cardiopulmonary complication rate of 86% was found for patients with a maximum oxygen uptake of less than 699 mL. min(-1). m(-2); for those with a value of 700 to 799 mL. min(-1). m(-2), the complication rate was 44%.


CONCLUSIONS
The maximum oxygen uptake obtained by expired gas analysis during exercise testing correlates with the postoperative cardiopulmonary complication rate. On the basis of these results, esophagectomy with 3-field lymphadenectomy can be safely performed in patients with a maximum oxygen uptake of at least 800 mL. min(-1). m(-2).
Nagamatsu
Y
Y
Department of Surgery, Saiseikai Yahata General Hospital, 5-9-27 Harunomachi Yahatahigashi-ku Kitakyushu City, 805-8527, Japan.
Shima
I
I
Yamana
H
H
Fujita
H
H
Shirouzu
K
K
Ishitake
T
T
D000328:Adult; D000368:Aged; D001784:Blood Gas Analysis; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods; D005080:Exercise Test; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D007321:Inspiratory Reserve Volume; D016015:Logistic Models; D008171:Lung Diseases / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013908:Thoracotomy