Abstract
Background: In the field of gastro-oesophageal cancer, the effect of chemotherapy treatment on patients’ cardiopulmonary fitness as well as on the incidence of post-operative cardiopulmonary complications remains controversial. Objectives: To examine the effect of chemotherapy on cardiopulmonary fitness. Further, to examine the association between cardiopulmonary exercise testing and other measurements on outcomes in patients with gastro-oesophageal cancer undergoing neo-adjuvant chemotherapy. And to compare post chemotherapy cardiopulmonary exercise testing with surgical outcome. Patients and methods: Forty-one patients with gastroesophageal cancer who underwent chemotherapy were referred to the Pulmonary Function Laboratory, Respiratory Medicine, Glasgow Royal Infirmary during the period August 2008 to December 2011. 35 of these patients underwent both pre- and post-chemotherapy pulmonary function testing and 31 of these 35 patients had their chemotherapy followed by surgery. A further 6 patients underwent chemotherapy followed by pulmonary function testing and surgery but without pre-chemotherapy testing Results: There were significant differences between the pre- and post-chemotherapy results in arterial PCO2 (p<0.01), t hemoglobin (p<0.001) and heart rate at anaerobic threshold as a % of maximum predicted heart rate (p<0.05). There were significant differences between those patients without post-operative complications and those with post-operative complications, in length of high dependency care stay (p<0.01), length of ward stay (p<0.05) and length of hospital stay (p<0.001) Conclusion: the results of the present study show that there was no significant change in cardiopulmonary fitness in patients with gastro-oesophageal cancer who underwent chemotherapy apart from correctable side effect such as anaemia. In addition, CPET parameters, pulmonary function tests and other related factors did not predict an increase in the risk of post-operative complications. There was, however, a relationship between deprivation and an increased risk of postoperative complications.
Highlights
The majority of cancer patients suffer from symptoms as a consequence of both their disease and its treatment
In the gastro-oesophageal field, some studies suggest that there is no additional benefit of chemotherapy in the treatment of oesophageal cancer as there is no variation in anastomotic leaks, pulmonary or cardiac complications with pre-operative chemotherapy compared to surgery alone. 6, 7, 8
In addition we have examined the association between pulmonary function measurements including CPET and outcomes in patients with gastro-oesophageal cancer undergoing neo-adjuvant chemotherapy
Summary
The majority of cancer patients suffer from symptoms as a consequence of both their disease and its treatment. In the gastro-oesophageal field, some studies suggest that there is no additional benefit of chemotherapy in the treatment of oesophageal cancer as there is no variation in anastomotic leaks, pulmonary or cardiac complications with pre-operative chemotherapy compared to surgery alone. There were significant differences between those patients without post-operative complications and those with post-operative complications, in length of high dependency care stay (p 0.01), length of ward stay (p 0.05) and length of hospital stay (p 0.001) Conclusion: the results of the present study show that there was no significant change in cardiopulmonary fitness in patients with gastro-oesophageal cancer who underwent chemotherapy apart from correctable side effect such as anaemia. CPET parameters, pulmonary function tests and other related factors did not predict an increase in the risk of post-operative complications. There was, a relationship between deprivation and an increased risk of postoperative complications
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