OGC P07 The utility of cardiopulmonary exercise testing (CPEX) in the management of patients with oesophago-gastric cancer

Abstract

Abstract Background The assessment of fitness for surgery of patients with oesophago-gastric (OG) cancer remains a challenge. Accurately “triaging” patients is vital in determining which patients with potentially operable cancer go forward for surgery. Over the last decade, CPEX has been introduced at most centres, although its utility remains unclear. Methods Between 2015-2020, 346 patients with OG cancer underwent pre-operative CPEX testing. The (i) anaerobic threshold (AT), (ii) maximum oxygen uptake at peak exercise (V ̇O2peak) and (iii) ventilatory equivalent for CO2 (VE/V CO2) were determined, and their influence on treatment outcomes ascertained. Results The MDT 'triaged' 27% of patients unfit for surgery based on their poor CPEX measures (AT: 11.2 vs. 10.2, p=0.002; VO2 peak: 20.3 vs. 17.1, p=0.001; VE/VE CO2: 1.81 vs. 1.58, p=0.001). 60/165 (36%) patients resected, suffered a Clavien-Dindo grade»3 complication, with no association with preoperative CPEX-derived variables (AT:10.9 vs 11.25, p=0.314; VO2 peak: 19.4 vs 19.4, p=0.825; VE/VECO2: 36.3 vs. 37.2, p=0.35). Multi-variate analysis demonstrated significant associations between poorer CPEX-derived measures and longer HDU stay (AT: p=0.016; VO2 peak: p=0.04), longer hospital stay (AT: p=0.027; VO2 peak: p=0.02) and higher 90-day mortality (AT: p=0.012; VO2 peak: p=0.04). Conclusions CPEX testing was a useful adjunct to the MDT algorithm in helping clinicians to triage patients for surgery. It was however not useful in identifying an “at risk” group within the subset considered fit for surgery.