754 STEEP RAMP TEST: AN ALTERNATIVE TO ASSESS PHYSICAL FITNESS BEFORE OESOPHAGECTOMY IN CANCER PATIENTS

Abstract

Abstract Oesophagectomy patients are at high risk of perioperative complications. An important predictor for a complication is inadequate preoperative physical fitness. Cardiopulmonary Exercise Test (CPET) is the golden standard for measuring VO₂ max. The Steep Ramp Test (SRT) is an alternative with a lower patient burden and cost, but provides an estimation of VO₂ max. The aim was to determine whether SRT is an adequate alternative for CPET to determine preoperative fitness in oesophageal cancer patients. Methods The population consisted of 113 oesophageal cancer patients of a single centre that have performed CPET and SRT within a timeframe of two weeks. The agreement between SRT and CPET was analysed using a t-test, the Pearson correlation, the Intraclass Correlation Coefficient (ICC) and the Bland-Altmann analysis. A CPET-measured VO₂ max of 17 mL/kg/min was the set threshold for adequate operative fitness, based on current literature. Results The mean difference between the CPET and SRT was 2.77 mL/kg/min (95% CI, 2.14–3.41). The Pearson correlation was 0.792 (P < 0.001). The ICC was 0.879 (95% CI, 0.825–0.917). In 93 (82.3%) patients, SRT was higher than the CPET. The limits of agreement (LOA) for the Bland-Altmann were − 3.89 − +9.44. Thirty-one (27.4%) patients performed better on SRT than the set threshold plus the upper LOA. Twenty-three patients scored inadequate on CPET, of whom 14 patients (60.9%) SRT was sufficient. Conclusion VO₂ max as estimated by SRT differs from the VO₂ max as measured by CPET. In patients that are well above the threshold of adequate preoperative fitness, the difference is of clinical irrelevance. In conclusion: SRT is a promising alternative to CPET for determining preoperative physical fitness, it might render CPET obsolete for fit individuals which leads to a lower burden for the patient and substantial cost reduction.