title: Cardiopulmonary exercise testing as a predictor of complications in oesophagogastric cancer surgery.
abstract: BACKGROUND
  An anaerobic threshold (AT) of <11 ml/min/kg can identify patients at high risk of cardiopulmonary complications after major surgery. The aim of this study was to assess the value of cardiopulmonary exercise testing (CPET) in predicting cardiopulmonary complications in high risk patients undergoing oesophagogastric cancer resection.
  
  
  METHODS
  Between March 2008 and October 2010, 108 patients (83 men, 25 women) with a median age of 66 years (range: 38-84 years) underwent CPET before potentially curative resections for oesophagogastric cancers. Measured CPET variables included AT and maximum oxygen uptake at peak exercise (VO2 peak). Outcome measures were length of high dependency unit stay, length of hospital stay, unplanned intensive care unit (ICU) admission, and postoperative morbidity and mortality.
  
  
  RESULTS
  The mean AT and VO2 peak were 10.8 ml/min/kg (standard deviation [SD]: 2.8 ml/min/kg, range: 4.6-19.3 ml/min/kg) and 15.2 ml/min/kg (SD: 5.3 ml/min/kg, range: 5.4-33.3 ml/min/kg) respectively; 57 patients (55%) had an AT of <11 ml/min/kg and 26 (12%) had an AT of <9 ml/min/kg. Postoperative complications occurred in 57 patients (29 cardiopulmonary [28%] and 28 non-cardiopulmonary [27%]). Four patients (4%) died in hospital and 21 (20%) required an unplanned ICU admission. Cardiopulmonary complications occurred in 42% of patients with an AT of <9 ml/min/kg compared with 29% of patients with an AT of ≥9 ml/min/kg but <11 ml/min/kg and 20% of patients with an AT of ≥11 ml/min/kg (p = 0.04). There was a trend that those with an AT of <11 ml/min/kg and a low VO2 peak had a higher rate of unplanned ICU admission.
  
  
  CONCLUSIONS
  This study has shown a correlation between AT and the development of cardiopulmonary complications although the discriminatory ability was low.
authors.affiliation: NHS Greater Glasgow and Clyde, UK. lhmoyes@gmail.com
authors.forename: L H
authors.initials: LH
authors.lastname: Moyes
authors.forename: C J
authors.initials: CJ
authors.lastname: McCaffer
authors.forename: R C
authors.initials: RC
authors.lastname: Carter
authors.forename: G M
authors.initials: GM
authors.lastname: Fullarton
authors.forename: C K
authors.initials: CK
authors.lastname: Mackay
authors.forename: M J
authors.initials: MJ
authors.lastname: Forshaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000601:surgery*; D005080:Exercise Test; D006331:Heart Diseases / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008171:Lung Diseases / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D012372:ROC Curve; D013274:Stomach Neoplasms / Q000601:surgery*; D016896:Treatment Outcome