Cardiopulmonary exercise test in preoperative risk stratification for lung resection: what is beyond oxygen consumption?

Abstract

Peak oxygen consumption (VO2) at cardiopulmonary exercise test (CPET), is a key variable in risk stratification for patients undergoing lung resection surgery, according to ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (2009). The relevance of other CPET variables was partially explored in literature, with mixed results. Our aim was to explore the role of CPET variables in risk stratification, in a cohort of patients considered fit for surgery according to the VO2 cut-off. We retrospectively analysed CPET data of patients underwent surgery for lung resection (Jan 2016 - June 2019). We defined as major complication: bronchopulmonary infections, pneumonia, sepsis, acute respiratory failure, acute heart failure, acute respiratory distress syndrome (ARDS). We enrolled 105 patients (mean age 67±9; 27% female), who underwent: pneumonectomy (5%), lobectomy (40%), segmentectomy (15%), wedge resection (42%). Twelve patients reported at least one event classified as major complication. We found a significant difference in the values of VE/VCO2 slope, end tidal pressure for CO2 and anaerobic threshold between patients presenting complications and those who did not (table 1). Our study shows that CPET provides important additional information for risk stratification in patients undergoing lung resection, even in a cohort already selected according to the VO2 criteria.