Abstract
BackgroundBoth preoperative cardiopulmonary exercise test (CPET)-derived measures of fitness and postoperative C-reactive protein (CRP) concentrations are associated with complications following surgery for colorectal cancer. The aim of the present pilot study was to examine the relationship between CPET and postoperative CRP concentrations in this patient group.MethodsPatients who had undergone CPET prior to elective surgery for histologically confirmed colorectal cancer in a single centre between September 2008 and April 2017 were included. Preoperative VO2 at the anaerobic threshold (AT) and peak exercise were recorded, along with preoperative modified Glasgow Prognostic Score (mGPS) and CRP on each postoperative day.ResultsThirty-eight patients were included. The majority were male (30, 79%), over 65 years old (30, 79%), with colonic cancer (23, 61%) and node-negative disease (24, 63%). Fourteen patients (37%) had open surgery and 24 (63%) had a laparoscopic resection. A progressive reduction in VO2 at peak exercise was significantly associated with both increasing American Society of Anesthesiology (ASA) grade (median, ml/kg/min: ASA 1 = 22, ASA 2 = 19, ASA 3 = 15, ASA 4 = 12, p = 0.014) and increasing mGPS (median, ml/kg/min: mGPS 0 = 18, mGPS 1 = 16, mGPS 2 = 14, p = 0.039) There was no significant association between either VO2 at the AT or peak exercise and postoperative CRP.ConclusionsThe present pilot study reports a possible association between preoperative CPET-derived measures of exercise tolerance, and the preoperative systemic inflammatory response, but not postoperative CRP in patients undergoing surgery for colorectal cancer.
Highlights
Both preoperative cardiopulmonary exercise test (CPET)-derived measures of fitness and postoperative C-reactive protein (CRP) concentrations are associated with complications following surgery for colorectal cancer
Two key measurements relating to oxygen delivery can be derived via CPET; oxygen consumption at the anaerobic threshold (VO2 at AT) which represents the point at which anaerobic metabolism is required in addition to aerobic metabolism to meet tissue energy demand, and oxygen consumption at peak exercise
The present pilot study confirms the relationship between CPET-derived measures of exercise tolerance and co-morbidity as measures by American Society of Anesthesiology (ASA) grade in patients prior to surgery for colorectal cancer
Summary
Both preoperative cardiopulmonary exercise test (CPET)-derived measures of fitness and postoperative C-reactive protein (CRP) concentrations are associated with complications following surgery for colorectal cancer. The aim of the present pilot study was to examine the relationship between CPET and postoperative CRP concentrations in this patient group. Cardiopulmonary exercise testing (CPET/CPX) has been developed as a method of assessing a patient’s ability to meet the increased oxygen demand of major surgery (Older et al, 1993). It represents a dynamic, non-invasive assessment of a patient’s cardiovascular and pulmonary reserve (Smith et al, 2009). Two key measurements relating to oxygen delivery can be derived via CPET; oxygen consumption at the anaerobic threshold (VO2 at AT) which represents the point at which anaerobic metabolism is required in addition to aerobic metabolism to meet tissue energy demand, and oxygen consumption at peak exercise
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