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Meta-Analysis
. 2007 Aug;101(8):1790-7.
doi: 10.1016/j.rmed.2007.02.012. Epub 2007 Apr 3.

Complications of lung resection and exercise capacity: a meta-analysis

Roberto Benzo  1 , George A Kelley, Laura Recchi, Albert Hofman, Frank Sciurba
Affiliations
Meta-Analysis

Complications of lung resection and exercise capacity: a meta-analysis

Roberto Benzo et al. Respir Med. 2007 Aug.

Abstract

Rationale: While exercise capacity, expressed as maximal oxygen consumption (VO2max), has been proposed to be the best predictor of postoperative cardiopulmonary complications after surgical resection in lung cancer patients, the literature remains controversial. The purpose of this study was to use the meta-analytic approach to determine if VO2max, expressed as either ml kg(-1) min(-1) or as a percentage of predicted, differed between patients who develop postoperative cardiopulmonary complications versus those that do not.

Methods: Studies were retrieved via (1) computerized literature searches, (2) cross referencing from retrieved articles, and (3) expert review of our reference list. Trials were included if they reported preoperative VO2max values (ml kg(-1) min(-1) or percentage of predicted) and had patients in which postoperative cardiopulmonary complications occurred.

Results: Fourteen studies representing a total of 955 men and women met our criteria for inclusion. Across all designs and categories, random-effects modeling demonstrated that patients without postoperative pulmonary complications had significantly higher levels of VO2max in ml kg(-1) min(-1) (mean difference=3.0, 95% confidence interval (CI), 1.9-4.0) as well as VO2max as a percentage of predicted (mean difference=8, 95% CI, 3.3-12.8).

Conclusion: After a systematic review of the literature, we found that exercise capacity, expressed as VO2max, is lower in patients that develop clinically relevant complications after curative lung resection. These results are important for the practicing clinician because they answer the literature controversy on the usefulness of measuring preoperative exercise capacity and reinforce the current guidelines on decision making for lung resection.

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Figures

Figure 1
Figure 1
Flow diagram of study selection.
Figure 2
Figure 2
Forest Plot for changes in VO2max in ml.kg−1.min−1 using a random effects model. The black boxes, sized relative to random-effects weighting, represent the mean change in VO2max in ml.kg−1.min−1 for each study while the lines represent the 95% confidence intervals. The diamond and dashed lines represent the overall mean change in VO2max in ml.kg−1.min−1 across all listed studies while the left and right ends of the diamond represent the 95% confidence interval for all studies combined.
Figure 3
Figure 3
Forest Plot for changes in VO2max (% predicted) using a random effects model. The black boxes, sized relative to random-effects weighting, represent the mean change in VO2max (% predicted) for each study while the lines represent the 95% confidence intervals. The diamond and dashed lines represent the overall mean change in VO2max (% predicted) across all listed studies while the left and right ends of the diamond represent the 95% confidence interval for all studies combined.
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References

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