Preoperative Cardiopulmonary Exercise Testing and 30-Day Postoperative Complications After Lung Resection for Non-Small Cell Lung Cancer: A Retrospective Cohort Study.

OBJECTIVES

We examined whether cardiopulmonary exercise testing (CPET) variables predict 30‑day postoperative complications in patients undergoing anatomical resection for non-small cell lung cancer (NSCLC).

METHODS

Consecutive patients who underwent segmentectomy or greater between January 2023 and March 2025 at a single tertiary centre were reviewed. All patients underwent CPET within 30 days preoperatively. Data on demographics, comorbidities, pulmonary function, operative factors, and outcomes were collected. Associations were assessed using univariable and multivariable logistic regression; discrimination was evaluated with receiver operating characteristic curve (ROC). Results with 2‑sided α = 0.05 were considered significant. Statistical analyses were conducted with R 4.4.2 (stats).

RESULTS

Among 353 patients (mean age 68.4 ± 8.4 years; 58.1% male individuals), 33 (9.4%) experienced complications. Patients were older (71.8 vs 68.0 years) and more often male individuals (81.8% vs 55.6%) than controls; they had lower body mass index (BMI) (23.1 vs 24.4 kg/m2) and lower forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) (69.5% vs 72.7%). In the univariable analysis, age (odds ratio [OR] 1.07), female sex (OR 0.28 vs male), BMI (OR 0.88 per kg/m2), FEV1/FVC (OR 0.96 per %), ventilatory equivalent for carbon dioxide (VE/VCO2) slope (OR 1.06 per unit), attained stage (OR 0.66 per stage), and operation time (OR 1.58 per hour) were associated with complications. In the multivariable analysis, BMI (OR 0.86, 95% confidence interval [CI] 0.75-1.00), FEV1/FVC (OR 0.94, 95% CI, 0.90-0.99), and VE/VCO2 slope (OR 1.06, 95% CI, 1.00-1.11) remained independent predictors. Receiver operating characteristic curves showed poor discrimination: peak oxygen consumption (VO2peak) area under the curve (AUC), 0.52; anaerobic threshold (AT), 0.59; VE/VCO2 slope, 0.40; and AT time 0.43. Dichotomized cut‑offs were generally non‑informative.

CONCLUSIONS

Individual CPET variables had limited discriminative accuracy (AUC < 0.6). Cardiopulmonary exercise testing should complement clinical and spirometric predictors rather than serve as a stand‑alone gatekeeper.