Abstract
AimAlthough cardiopulmonary exercise testing (CPET) is considered the gold standard, a preoperative abdominal CT scan might also provide information concerning preoperative aerobic fitness for risk assessment. This study aimed to investigate the association between preoperative CT‐scan‐derived body composition variables and preoperative CPET variables of aerobic fitness in colorectal surgery.MethodIn this retrospective cohort study, CT images at level L3 were analysed for skeletal muscle mass, skeletal muscle radiation attenuation, visceral adipose tissue (VAT) mass and subcutaneous adipose tissue mass. Regression analyses were performed to investigate the relation between CT‐scan‐derived body composition variables, CPET‐derived aerobic fitness and other preoperative patient‐related variables. Logistic regression analysis was performed to predict a preoperative anaerobic threshold (AT) ≤ 11.1 ml/kg/min as cut‐off for having a high risk for postoperative complications.ResultsData from 78 patients (45 men; mean [SD] age 74.5 [6.4 years]) were analysed. A correlation coefficient of 0.55 was observed between absolute AT and skeletal muscle mass index. Absolute AT (R 2 of 51.1%) was lower in patients with a lower skeletal muscle mass index, together with higher age, lower body mass and higher American Society of Anesthesiologists (ASA) score. Higher ASA score (odds ratio 5.64; P = 0.033) and higher VAT mass (odds ratio 1.02; P = 0.036) were associated with an increased risk of an AT ≤ 11.1 ml/kg/min.ConclusionBody composition variables from the preoperative CT scan were moderately associated with preoperative CPET‐derived aerobic fitness. Higher ASA score and higher VAT mass were associated with an increased risk of an AT ≤ 11.1 ml/kg/min.
Highlights
Colorectal cancer is the third most common type of cancer [1]
A multivariable logistic regression analysis was performed to investigate if a preoperative relative anaerobic threshold (AT) ≤ 11.1 ml/kg/min can be predicted from body composition variables derived from the abdominal CT scan and other patient characteristics
This study aimed to investigate the association between body composition variables derived from the preoperative abdominal CT scan and preoperative cardiopulmonary exercise testing (CPET) variables of aerobic fitness in patients scheduled for colorectal surgery, to evaluate whether the preoperative CT scan canselect unfit patients
Summary
Colorectal cancer is the third most common type of cancer [1]. After resection for colon or rectal carcinoma, 15% and 20% of the patients respectively have a complicated course within 30 days after surgery, which might lead to a prolonged hospital stay of >14 days or even mortality [2]. Preoperative risk assessment might identify patients at high risk of postoperative complications; these patients may benefit from preoperative preventive interventions (prehabilitation) [4,5]. Cardiopulmonary exercise testing (CPET) is increasingly utilized for risk assessment before major surgery to evaluate the risk of adverse perioperative events [5]. CPET is an objective and precise method of evaluating a patient's preoperative aerobic fitness. Patients with a lower oxygen uptake at the anaerobic threshold (AT) and/or a lower oxygen uptake at peak exercise (VO2peak) have an increased risk of postoperative complications [6–9]. Despite its usefulness in perioperative medicine, CPET is not always available in clinical practice, is relatively expensive and time-consuming, and requires well-trained personnel for an adequate interpretation of its results
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