Cardiopulmonary Exercise Test parameters as predictors of postoperative morbidity in lung cancer surgery

Abstract

Introduction: Despite advances in surgical techniques and anaesthetic management in lung cancer surgery, cardiopulmonary complications are the most important causes of postoperative morbimortality. The aim of this study was to evaluate Cardiopulmonary Exercise Test (CPET) parameters as predictors of postoperative complications in lung cancer surgery patients. Method: This observational prospective study included patients who were candidates for lung cancer surgery (LCS) at our hospital. Patients with either a post-bronchodilator FEV1% or DLCO Results: 118 patients were included, (71% men); mean age was: 66 + 10 years; mean FEV1 (%): 69 ± 14 and mean DLCO (%) = 68 ± 16. The mean VO2 max (ml/kg/min) was 18 ± 4. The incidence of complications was 16% (84.8% of total complications were respiratory). Table 1 shows the clinical, functional and CPET characteristics of patients according to the presence of complications. After adjusting for perioperative factors by logistic regression, the best predictor factors of postoperatorive total complications were exercise VE/VCO2 slope and VE max (OR: 1,12, p=0,018; OR: 0,95; p=0,019, respectively). For postoperative respiratory complications, the best predictor factors were VO2 max and FEV1/FVC (OR=0.751, p=0.003; OR=0.932, p=0.006, respectively) Conclusions: The predictive capacity of VO2 max and VE/VCO2 for postoperative morbidity supports the use of CPET as a tool to improve the stratification of risks in lung cancer patients. These results reaffirm the inclusion of the CPET in the first steps of preoperative risk assessment algorithms.