title: Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery.
abstract: BACKGROUND
  This study investigated the relationship between objectively measured physical fitness variables derived by cardiopulmonary exercise testing (CPET) and in-hospital morbidity after rectal cancer surgery.
  
  
  METHODS
  Patients scheduled for rectal cancer surgery underwent preoperative CPET (reported blind to patient characteristics) with recording of morbidity (recorded blind to CPET variables). Non-parametric receiver operating characteristic (ROC) curves and logistic regression were used to assess the relationship between CPET variables and postoperative morbidity.
  
  
  RESULTS
  Of 105 patients assessed, 95 (72 men) were included; ten patients had no surgery and were excluded (3 by choice, 7 owing to unresectable metastasis). Sixty-eight patients had received neoadjuvant treatment. ROC curve analysis of oxygen uptake (V˙o2 ) at estimated lactate threshold (θ^L ) and peak V˙o2 gave an area under the ROC curve of 0·87 (95 per cent confidence interval 0·78 to 0·95; P < 0·001) and 0·85 (0·77 to 0·93; P < 0·001) respectively, indicating that they can help discriminate patients at risk of postoperative morbidity. The optimal cut-off points identified were 10·6 and 18·6 ml per kg per min for V˙o2 at θ^L and peak respectively.
  
  
  CONCLUSIONS
  CPET can help predict morbidity after rectal cancer surgery.
authors.affiliation: Colorectal Surgery Research Group, Department of Surgery, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK; Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, Liverpool, UK; Critical Care Research Area, National Institute for Health Research Respiratory Biomedical Research Unit, Southampton, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: West
authors.forename: M G
authors.initials: MG
authors.lastname: Parry
authors.forename: D
authors.initials: D
authors.lastname: Lythgoe
authors.forename: C P
authors.initials: CP
authors.lastname: Barben
authors.forename: G J
authors.initials: GJ
authors.lastname: Kemp
authors.forename: M P W
authors.initials: MP
authors.lastname: Grocott
authors.forename: S
authors.initials: S
authors.lastname: Jack
mesh_terms: D000368:Aged; D005080:Exercise Test / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D020360:Neoadjuvant Therapy; D010101:Oxygen Consumption / Q000502:physiology; D010809:Physical Fitness / Q000502:physiology*; D011183:Postoperative Complications / Q000209:etiology* / Q000503:physiopathology; D011300:Preoperative Care / Q000379:methods; D012372:ROC Curve; D012004:Rectal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D016896:Treatment Outcome