Abstract
BackgroundThe extent to which physiological factors influence outcome following oesophageal cancer surgery is poorly understood. This study aimed to evaluate the extent to which cardiorespiratory fitness and selected metabolic factors predicted complications after surgery for carcinoma.MethodsTwo hundred and twenty‐five consecutive patients underwent preoperative cardiopulmonary exercise testing to determine peak oxygen uptake (V˙ o 2peak), anaerobic threshold and the ventilatory equivalent for carbon dioxide (V˙ e/V˙ co 2). Cephalic venous blood was assayed for serum C‐reactive protein (CRP) and albumin levels, and a full blood count was done. The primary outcome measure was the Morbidity Severity Score (MSS).ResultsOne hundred and ninety‐eight patients had anatomical resection. A high MSS (Clavien–Dindo grade III or above) was found in 48 patients (24·2 per cent) and was related to an increased CRP concentration (area under the receiver operating characteristic (ROC) curve (AUC) 0·62, P = 0·001) and lower V˙ o 2peak (AUC 0·36, P = 0·003). Dichotomization of CRP levels (above 10 mg/l) and V˙ o 2peak (below 18·6 ml per kg per min) yielded adjusted odds ratios (ORs) for a high MSS of 2·86 (P = 0·025) and 2·92 (P = 0·002) respectively. Compared with a cohort with a low Combined Inflammatory and Physiology Score (CIPS), the OR was 1·70 (95 per cent c.i. 0·85 to 3·39) for intermediate and 27·47 (3·12 to 241·69) for high CIPS (P < 0·001).ConclusionCRP and V˙ o 2peak were independently associated with major complications after potentially curative oesophagectomy for cancer. A composite risk score identified a group of patients with a high risk of developing complications.
Highlights
Oesophagectomy remains the primary therapeutic modality for potentially curative treatment for patients with oesophageal cancer
In view of the above, the present study examined the extent to which select measures of cardiorespiratory fitness and metabolic markers of inflammation can predict clinical outcome in patients with oesophageal cancer scheduled for elective surgery
Ethical approval was sought from the regional ethics committee, but a formal application was deemed unnecessary because the study was considered to be a service evaluation of consecutively recruited patients, for whom consent had already been provided
Summary
Oesophagectomy remains the primary therapeutic modality for potentially curative treatment for patients with oesophageal cancer. CPET, in particular an anaerobic threshold of less than 11 ml per kg per min, has been reported to predict postoperative morbidity and mortality in patients undergoing major abdominal surgery[8,9,10]. The primary outcome measure was the Morbidity Severity Score (MSS). A high MSS (Clavien–Dindo grade III or above) was found in 48 patients (24⋅2 per cent) and was related to an increased CRP concentration (area under the receiver operating characteristic (ROC) curve (AUC) 0⋅62, P = 0⋅001) and lower V O2peak (AUC 0⋅36, P = 0⋅003). Conclusion: CRP and V O2peak were independently associated with major complications after potentially curative oesophagectomy for cancer. Funding information Royal Society Wolfson Research Fellowship, WM170007 Royal Society International Exchanges Award, IES\R2\192137 Japan Society for the Promotion of Science Research Fellowship, JSPS/OF317
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