title: 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.
abstract: 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).
authors.affiliation: Department of Surgery, Saiseikai Yahata General Hospital, 5-9-27 Harunomachi Yahatahigashi-ku Kitakyushu City, 805-8527, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Nagamatsu
authors.forename: I
authors.initials: I
authors.lastname: Shima
authors.forename: H
authors.initials: H
authors.lastname: Yamana
authors.forename: H
authors.initials: H
authors.lastname: Fujita
authors.forename: K
authors.initials: K
authors.lastname: Shirouzu
authors.forename: T
authors.initials: T
authors.lastname: Ishitake
mesh_terms: 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