title: Complications of lung resection and exercise capacity: a meta-analysis.
abstract: BACKGROUND
  While exercise capacity, expressed as maximal oxygen consumption (VO2max), has been proposed to be the best predictor of postoperative cardiopulmonary complications after surgical resection in lung cancer patients, the literature remains controversial. The purpose of this study was to use the meta-analytic approach to determine if VO2max, expressed as either ml kg(-1) min(-1) or as a percentage of predicted, differed between patients who develop postoperative cardiopulmonary complications versus those that do not.
  
  
  METHODS
  Studies were retrieved via (1) computerized literature searches, (2) cross referencing from retrieved articles, and (3) expert review of our reference list. Trials were included if they reported preoperative VO2max values (ml kg(-1) min(-1) or percentage of predicted) and had patients in which postoperative cardiopulmonary complications occurred.
  
  
  RESULTS
  Fourteen studies representing a total of 955 men and women met our criteria for inclusion. Across all designs and categories, random-effects modeling demonstrated that patients without postoperative pulmonary complications had significantly higher levels of VO2max in ml kg(-1) min(-1) (mean difference=3.0, 95% confidence interval (CI), 1.9-4.0) as well as VO2max as a percentage of predicted (mean difference=8, 95% CI, 3.3-12.8).
  
  
  CONCLUSIONS
  After a systematic review of the literature, we found that exercise capacity, expressed as VO2max, is lower in patients that develop clinically relevant complications after curative lung resection. These results are important for the practicing clinician because they answer the literature controversy on the usefulness of measuring preoperative exercise capacity and reinforce the current guidelines on decision making for lung resection.
authors.affiliation: Division of Pulmonary & Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA. benzorp@upmc.edu
authors.forename: Roberto
authors.initials: R
authors.lastname: Benzo
authors.forename: George A
authors.initials: GA
authors.lastname: Kelley
authors.forename: Laura
authors.initials: L
authors.lastname: Recchi
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Frank
authors.initials: F
authors.lastname: Sciurba
mesh_terms: D000368:Aged; D005080:Exercise Test; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis*; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000175:diagnosis*; D012307:Risk Factors