High Tech Exercise Testing in Assessing Candidates for Lung Resection



Fig. 8.1
Methods of literature search and selection





Results


The use of CPET in the preoperative evaluation of patients considered for lung resection was proposed more than 30 years ago. Eugene and colleagues highlighted the ability of maximum oxygen consumption (VO2max) (expressed as absolute value in ml) in predicting the postoperative complications better than the pulmonary function test in a group of 19 patients [4]. Some years later Bolliger and colleagues corroborated these data publishing two different papers in larger cohorts of patients [5, 6]. They emphasized the role of VO2max expressed as percent of predicted value in defining the risk of lung resection. In particular, in a series of 125 surgical candidates for anatomic lung resection submitted to an exhaustive preoperative evaluation including CPET, they found that 90 % of the patients with a VO2max <60 % of predicted values experienced a postoperative complication.

During the last 10 years, many other papers confirmed the role of CPET as the gold standard in the functional preoperative evaluation of lung resection candidates. These papers, as shown in Fig. 8.1 were selected and analyzed for the present review, following the above mentioned criteria. Table 8.1summarizes the original articles studying the association between VO2max measured during CPET and the postoperative risk of morbidity and mortality following lung resection.


Table 8.1
Original papers on VO2max and postoperative morbidity and mortality




































































































Study

Patients

Evaluation protocol

Outcome

Results

Quality of evidence

Win et al. [7]

101 candidates to anatomic lung resection

Systematic CPET (estimation of VO2max and VO2max%)

Postsurgical complications including mortality

VO2max% >50: complication rate 10 %

Moderate

VO2max% <50: complication rate 67 %

VO2max% >60: complication rate 9 %

VO2max% <60: complication rate 36 %

Bayram et al. [8]

55 candidates to anatomic lung resection

Systematic CPET (estimation of VO2max)

Postsurgical complications including mortality

VO2max >15 ml/kg/min: complication rate 0

Low

VO2max <15 ml/kg/min: complication rate 40 %

Loewen et al. [9]

346 candidates to anatomic lung resection (multiinstitutional)

Systematic CPET (estimation of VO2max and VO2max%)

Postsurgical complications including mortality

VO2max <15 ml/kg/min or <65 % associated with mortality and cardiopulmonary morbidity

Moderate

Brunelli et al. [10]

204 candidates to anatomic lung resection

Systematic CPET (estimation of VO2max and VO2max%)

Cardiopulmonary complications and death

VO2max <12 ml/kg/min: complication rate 33 % and mortality rate 13 %;

Moderate

VO2 max >20 ml/kg/min complication rate: 7 % and mortality rate 0

Bobbio et al. [11]

73 candidates to anatomic lung resection

Systematic CPET (estimation of VO2max)

Postsurgical complications including mortality

VO2max not associated with outcome

Low

Licker et al. [12]

210 candidates to anatomic lung resection (with FEV1 <80 %)

CPET (estimation of VO2max and VO2max%)

Cardiopulmonary complications including mortality

VO2max <10 ml/kg/min: complication rate 65 %

Moderate

VO2max >10 ml/kg/min: complication rate 17.7 %

Kasikcioglu et al. [13]

49 candidates to anatomic lung resection

Systematic CPET (estimation of VO2max and Oxygen uptake kinetics)

Cardiopulmonary complications including mortality

VO2 max and oxygen uptake kinetics associated with poor outcome

Low

Campione et al. [14]

49 candidates to anatomic lung resection (retrospective)

Systematic CPET (estimation of VO2max, HR at peak and Oxygen pulse)

Cardiopulmonary complications including mortality

Only HR at peak and oxygen pulse associated with poor outcome

Low

Torchio et al. [15]

145 selected candidates to anatomic lung resection

CPET (estimation of VO2max, and VE/VCO2 slope)

Cardiopulmonary complications and death

VE/VCO2 slope ≥34: mortality rate 5.5 %; VO2max associated with complications

Moderate

Brunelli et al. [16]

225 candidates to anatomic lung resection

Systematic CPET (estimation of VO2max and VE/VCO2 slope)

Respiratory complications

VE/VCO2 >35: complication rate 22 % and mortality rate 7.2 %

Moderate


CPET Cardiopulmonary exercise test, HR heart rate, VO2max maximum oxygen consumption, VE/VCO2 ventilation to carbon dioxide production ratio, FEV1 forced expiratory volume in 1 s

In 2005 Win and colleagues [7] published a prospective study on 101 patients evaluated by CPET and then submitted to curative lung surgery. They found that the VO2max expressed as percentage of predicted was the only parameter associated with surgical complications and death and concluded that a VO2max <50 % of predicted should identify a high risk category of patients.

In 2007, two different studies confirmed the role of VO2max, expressed as ml/kg/min, as a predictor of cardiopulmonary complications including death. Bayram and colleagues [8] in a cohort of 55 patients submitted to major lung resection found a correlation between poor surgical outcome and a VO2max <15 ml/kg/min. They registered no cardiopulmonary morbidity or mortality for patients with a VO2max >15 ml/kg/min. Similarly, Loewen and colleagues reported the data of the Protocol 9,238 of the Cancer and Leukemia Group B investigating the ability of VO2 measurement in predicting the surgical risk in lung resection [9]. Again, they found that the patients with a VO2max <15 ml/kg/min were exposed to a higher risk of postoperative respiratory failure and death.

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Dec 30, 2016 | Posted by in CARDIOLOGY | Comments Off on High Tech Exercise Testing in Assessing Candidates for Lung Resection

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