Cardiopulmonary exercise variables and their association with postoperative morbidity and mortality after major oesophagogastric cancer surgery-a multicentre observational study.
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West Malcolm A, Rahman Saqib, Jack Sandy, Grocott Michael P W, Levett Denny Z H, Perioperative Exercise Testing and Training Society (POETTS), Rashid Yasir, Griffiths John, Ezra Martin, Ayres Lyndsay, Neville-Webbe Helen, Javed Muhammad Shafiq, Shrotri Milind, Khan Iftikhar, Whitmore David, Prabhu Pradeep, Timbrell David, Allen Sophie, Packham Andrew O, Sharpe David, Anderson Helen, Minto Gary, McAleer Samuel, McPhail Stuart, Alasmar Mohamed, Hartley Robert A, Sultan Javed, Grace Ben, Underwood Timothy J, Byrne James, Noble Fergus, Kelly Jamie, Ansell Gillian, Edwards Mark
Аннотация
METHODS: Patients undergoing oesophagogastric cancer resection and CPET (pre- or post-neoadjuvant treatment, or both) were retrospectively enrolled into a multicentre pooled cohort study. Oxygen uptake at peak exercise (VO2 peak) was compared with 1-yr postoperative survival. Secondary analyses explored relationships between patient characteristics, tumour pathology characteristics, CPET variables (absolute, relative to weight, ideal body weight, and body surface area), and postoperative outcomes (morbidity, 1-yr and 3-yr survival) were assessed using logistic regression analyses.
RESULTS: Seven UK centres recruited 611 patients completing a 3-yr postoperative follow-up period. Oesophagectomy was undertaken in 475 patients (78%). Major complications occurred in 25%, with 18% 1-yr and 43% 3-yr mortality. No association between VO2 peak or other selected CPET variables and 1-yr survival was observed in the overall cohort. In the overall cohort, the anaerobic threshold relative to ideal body weight was associated with 3-yr survival (P=0.013). Tumour characteristics (ypT/ypN/tumour regression/lymphovascular invasion/resection margin; P<0.001) and Clavien-Dindo ≥3a (P<0.001) were associated with 1-yr and 3-yr survival. On subgroup analyses, pre-neoadjuvant treatment CPET; anaerobic threshold (absolute; P=0.024, relative to ideal body weight; P=0.001, body surface area; P=0.009) and VE/VCO2 at anaerobic threshold (P=0.026) were associated with 3-yr survival. No other CPET variables (pre- or post-neoadjuvant treatment) were associated with survival.
CONCLUSIONS: VO2 peak was not associated with 1-yr survival after oesophagogastric cancer resection. Tumour characteristics and major complications were associated with survival; however, only some selected pre-neoadjuvant treatment CPET variables were associated with 3-yr survival. CPET in this cohort of patients demonstrates limited outcome predictive precision.
CLINICAL TRIAL REGISTRATION: NCT03637647.