Abstract
The 6-min walk test (6MWT) is a simple method of identifying patients with a high risk of postoperative complications. In this study, we internally validated the previously obtained threshold value of 500 m in the 6MWT as differentiating populations with a high and a low risk of postoperative complications after a lobectomy. Between November 2011 and November 2016, 624 patients who underwent a lobectomy and performed the 6MWT preoperatively entered this study. We compared the complication rates of two groups of patients—those who walked more than and those who walked less than 500 m. The patients who did not reach the distance of 500 m in the 6MWT were older (70 vs. 63 years p < 0.001), had worse pulmonary function tests (FEV1% 84 vs. 88 p = 0.041) and had a higher Charlson Comorbidity Index (p < 0.001). The patients who had a worse result in the 6MWT had a higher complication rate (52% vs. 42% p = 0.019; OR: 1.501 95% CI: 1.066–2.114) and a longer median postoperative hospital stay (7 vs. 6 days p = 0.010). In a multivariate analysis, the result of the 6MWT and pack-years proved to independently influence the risk of postoperative complications. This internal validation study confirms that 500 m is a result of the 6MWT which differentiates patients with a higher risk of postoperative complications and a prolonged hospital stay after a lobectomy.
Highlights
Surgical treatment of patients with lung cancer is, in most cases, associated with an inevitable deterioration of their general well-being
The aim of the present study was to validate the result of 500 m in the 6-min walk test (6MWT) as an indicator of patients with an increased risk of postoperative complications after a lobectomy performed due to lung cancer
Complications were more common in the group of patients with a 6-min walk distance (6MWD) shorter than 500 m [52.4% vs. 42.3 Odds ratios (ORs) 1.501]
Summary
Surgical treatment of patients with lung cancer is, in most cases, associated with an inevitable deterioration of their general well-being This fact requires clinicians to reliably obtain tools which will assess the perioperative risk. Despite the commonly accepted guidelines on physiological qualification for lung cancer surgery [1,2], there is an ongoing discussion on their further optimization. These guidelines recommend assessment of the preoperative and calculation of predicted postoperative values of forced expiratory volume in the first second (FEV1) and diffusing capacity of the lungs for carbon monoxide (DLCO). In the literature, there are conflicting (or not overlapping) thresholds of the stair climbing test [5], shuttle walk test [6], DLCO and FEV1 [7] or CPET [8], which raises the question about their exact clinical meaning
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