Is cardiopulmonary exercise testing a useful test before esophagectomy?
BACKGROUND
Cardiopulmonary exercise (CPX) testing may identify patients at high risk of postoperative cardiopulmonary morbidity and mortality. This study aims to assess the utility of CPX testing before esophagectomy.


METHODS
Between January 2004 and October 2006, 78 consecutive patients (64 men) with a median age of 65 years (range, 40 to 81 years) underwent CPX testing before esophagectomy (50% transhiatal; 50% transthoracic). Measured variables included anaerobic threshold (AT) and maximum oxygen uptake at peak exercise (VO2peak). Outcome measures were postoperative morbidity and mortality, length of hospital stay, and unplanned intensive therapy unit admission.


RESULTS
Cardiopulmonary complications occurred in 33 (42%) patients and noncardiopulmonary complications in 19 (24%). One in-hospital death (1.3%) occurred, and 13 patients (17%) required an unplanned intensive therapy unit admission. The level of VO2peak was significantly lower in patients with postoperative cardiopulmonary morbidity (p = 0.04). The area under a receiver operating characteristic curve was 0.63 (95% confidence interval [CI], 0.50 to 0.76) for the VO2peak and 0.62 (95% CI, 0.49 to 0.75) for AT. An AT cutoff of 11 mL/kg/min was a poor predictor of postoperative cardiopulmonary morbidity.


CONCLUSIONS
Although the VO2peak was significantly lower in those patients who developed cardiopulmonary complications, CPX testing is of limited value in predicting postoperative cardiopulmonary morbidity in patients undergoing esophagectomy.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015308:Anaerobic Threshold; D015331:Cohort Studies; D016629:Esophagectomy / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008171:Lung Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome