Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Nov;28(12):7120-7146.
doi: 10.1245/s10434-021-10251-3. Epub 2021 Jun 8.

Preoperative Cardiopulmonary Exercise Test Associated with Postoperative Outcomes in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analyses

Daniel Steffens  1   2 , Hilmy Ismail  3   4 , Linda Denehy  3   4 , Paula R Beckenkamp  5 , Michael Solomon  6   7 , Cherry Koh  6   7 , Jenna Bartyn  6 , Neil Pillinger  6   7
Affiliations
Meta-Analysis

Preoperative Cardiopulmonary Exercise Test Associated with Postoperative Outcomes in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analyses

Daniel Steffens et al. Ann Surg Oncol. 2021 Nov.

Abstract

Backgrounds: There is mixed evidence on the value of preoperative cardiorespiratory exercise test (CPET) to predict postoperative outcomes in patients undergoing a cancer surgical procedure. The purpose of this review was to investigate the association between preoperative CPET variables and postoperative complications, length of hospital stay, and quality of life in patients undergoing cancer surgery.

Methods: A search was conducted on MEDLINE, Embase, AMED, and Web of science from inception to April 2020. Cohort studies investigating the association between preoperative CPET variables, including peak oxygen uptake (peak VO2), anaerobic threshold (AT), or ventilatory equivalent for carbon dioxide (VE/VCO2), and postoperative outcomes (complications, length of stay, and quality of life) were included. Risk of bias was assessed using the QUIPS tool. A random-effect model meta-analysis was performed whenever possible.

Results: Fifty-two unique studies, including 10,030 patients were included. Overall, most studies were rated as having low risk of bias. Higher preoperative peak VO2 was associated with absence of postoperative complications (mean difference [MD]: 2.28; 95% confidence interval [CI]: 1.26-3.29) and no pulmonary complication (MD: 1.47; 95% CI: 0.49-2.45). Preoperative AT and VE/VCO2 also demonstrated some positive trends. None of the included studies reported a negative trend.

Conclusions: This systematic review and meta-analysis demonstrated a significant association between superior preoperative CPET values, especially peak VO2, and better postoperative outcomes. The assessment of preoperative functional capacity in patients undergoing cancer surgery has the potential to facilitate treatment decision making.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Included studies
Fig. 2
Fig. 2
Forest plot of the association between preoperative peak oxygen uptake (peak VO2) in ml/kg/min and postoperative complication. Mean difference > 0 indicate higher preoperative peak VO2 in patients with no postoperative complications. CI=Confidence level
Fig. 3
Fig. 3
Forest plot of the association between preoperative anaerobic threshold (AT) in ml\kg\min and postoperative complication. Mean difference>0 indicate higher preoperative AT in Patients with no postoperative complications. CI = Confidence level
Fig. 4
Fig. 4
Forest plot of the association between preoperative ventilatory equivalent for carbon dioxide (VE/VCO2) and postoperative complications. Mean difference >0 indicate lower preoperative VE/VCO2 in patients with no postoperative complications. CI=Confidence level
See this image and copyright information in PMC

Comment in

References

    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi: 10.3322/caac.21492. - DOI - PubMed
    1. Steffens D, Koh C, Ansari N, Solomon MJ, Brown K, McBride K, et al. Quality of life after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: early results from a prospective cohort study of 115 patients. Ann Surg Oncol. 2020;27(10):3986–3994. doi: 10.1245/s10434-020-08443-4. - DOI - PubMed
    1. Steffens D, Solomon MJ, Young JM, Koh C, Venchiarutti RL, Lee P, et al. Cohort study of long-term survival and quality of life following pelvic exenteration. BJS Open. 2018;2(5):328–335. doi: 10.1002/bjs5.75. - DOI - PMC - PubMed
    1. Bolliger CT, Perruchoud AP. Functional evaluation of the lung resection candidate. Eur Respir J. 1998;11(1):198–212. doi: 10.1183/09031936.98.11010198. - DOI - PubMed
    1. Sivakumar J, Sivakumar H, Read M, Sinclair RCF, Snowden CP, Hii MW. The role of cardiopulmonary exercise testing as a risk assessment tool in patients undergoing oesophagectomy: a systematic review and meta-analysis. Ann Surg Oncol. 2020;27(10):3783–3796. doi: 10.1245/s10434-020-08638-9. - DOI - PubMed