P-OGC19 The predictive role of cardiopulmonary exercise testing in gastric cancer surgery

Abstract

Abstract Background The role of Cardiopulmonary Exercise Testing (CPET) prior to major surgery has been an area of growing interest over the last two decades. CPET offers an objective and composite measure of physiological functional reserve, and thus can be used to identify patients at highest risk of peri-operative morbidity and mortality. Although the role of CPET has been investigated with respect to outcomes after oesophagectomy, no clear data exist into the predictive role of CPET specifically relating to gastric cancer surgery. The aim of this study was to identify CPET parameters predictive of adverse outcome in patients undergoing curative gastric resections. Methods Patients who underwent CPET followed by curative total or subtotal gastrectomy for gastric or junctional adenocarcinoma between January 2013 and December 2019 in a single high-volume centre were included in retrospective analysis. CPET variables were categorised as per cut-off values from other surgical populations (AT < 11ml.min-1.kg-1, VO2peak<15ml.min-1.kg-1, VE/VCO2 at AT > 34). Associations between these variables and postoperative outcomes were analysed using chi squared or Fisher’s exact test. Results There were 252 patients included in the study. Patients with VE/VCO2>34 were more likely to return to the intensive care unit (ICU) (p = 0.033) and had a higher chance of in-hospital mortality (p = 0.012). AT < 11ml.min-1.kg-1 or VO2peak<15ml.min-1.kg-1 were not associated either with return to ICU (p = 0.243, p = 0.202) or with in-hospital mortality (p = 1.000, p = 1.000). Conclusions Although much has been published on the importance of CPET assessment prior to major abdominal surgery, there is a paucity of literature specifically looking at its role in patients with gastric cancer. Patients with ventilatory inefficiency (VE/VCO2>34) are more likely to return to ICU or to die during hospital stay after total/subtotal gastrectomy for malignant disease. This information should play a more prominent role when assessing patients’ fitness prior to surgery.