title: Pre-operative cardiopulmonary exercise testing predicts adverse post-operative events and non-progression to adjuvant therapy after major pancreatic surgery.
abstract: BACKGROUND
  Surgery followed by chemotherapy is the primary modality of cure for patients with resectable pancreatic cancer but is associated with significant morbidity. The aim of the present study was to evaluate the role of cardiopulmonary exercise testing (CPET) in predicting post-operative adverse events and fitness for chemotherapy after major pancreatic surgery.
  
  
  METHODS
  Patients who underwent a pancreaticoduodenectomy or total pancreatectomy for pancreatic head lesions and had undergone pre-operative CPET were included in this retrospective study. Data on patient demographics, comorbidity and results of pre-operative evaluation were collected. Post-operative adverse events, hospital stay and receipt of adjuvant therapy were outcome measures.
  
  
  RESULTS
  One hundred patients were included. Patients with an anaerobic threshold less than 10 ml/kg/min had a significantly greater incidence of a post-operative pancreatic fistula [International Study Group for Pancreatic Surgery (ISGPS) Grades A-C, 35.4% versus 16%, P = 0.028] and major intra-abdominal abscesses [Clavien-Dindo (CD) Grades III-V, 22.4% versus 7.8%, P = 0.042] and were less likely to receive adjuvant therapy [hazard ratio (HR) 6.30, 95% confidence interval (CI) 1.25-31.75, P = 0.026]. A low anaerobic threshold was also associated with a prolonged hospital stay (median 20 versus 14 days, P = 0.005) but not with other adverse events.
  
  
  CONCLUSIONS
  CPET predicts a post-operative pancreatic fistula, major intra-abdominal abscesses as well as length of hospital stay after major pancreatic surgery. Patients with a low anaerobic threshold are less likely to receive adjuvant therapy.
authors: Academic Department of Surgery, University of Glasgow, Glasgow, UK.
authors: Vishnu V
authors: VV
authors: Chandrabalan
authors: Academic Department of Surgery, University of Glasgow, Glasgow, UK.
authors: Donald C
authors: DC
authors: McMillan
authors: Department of Respiratory Medicine, Glasgow Royal Infirmary, Glasgow, UK.
authors: Roger
authors: R
authors: Carter
authors: Section of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK.
authors: John
authors: J
authors: Kinsella
authors: West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK.
authors: Colin J
authors: CJ
authors: McKay
authors: West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK.
authors: C Ross
authors: CR
authors: Carter
authors: West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK.
authors: Euan J
authors: EJ
authors: Dickson
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control; D018450:Disease Progression; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012140:Respiratory Tract Diseases / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control