Role of Cardiopulmonary Exercise Testing in Predicting Perioperative Outcomes in Cancer Patients Undergoing Thoracoabdominal Surgeries; an Observational Cohort Study

  • Sadia Sadaqat Department of Anesthesia, Shaukat Khanum Memorial Cancer Hospital & Research Centre
  • Ahsun Waqar Khan Department of Anesthesia, Shaukat Khanum Memorial Cancer Hospital & Research Centre
  • Allah Ditta Ashfaq Department of Anesthesia, Shaukat Khanum Memorial Cancer Hospital & Research Centre https://orcid.org/0000-0001-5089-7635
  • Shafiq Ur Rehman Department of Anesthesia, Shaukat Khanum Memorial Cancer Hospital & Research Centre
Keywords: Anaerobic threshold, maximum oxygen consumption, metabolic equivalents, morbidity, mortality

Abstract

Introduction: The cancer patients are at a high risk of developing perioperative complications. Cardiopulmonary exercise testing (CPET) is a non-invasive, perioperative risk stratification tool that predicts perioperative morbidity and mortality. Prior literature has concluded that CPET has a valuable role in predicting post-operative complications in major surgical procedures. However, the data on the effectiveness of CPET in evaluating the perioperative risk in cancer-specific populations are limited. This study assessed the usefulness of CPET in perioperative risk stratification of patients with thoracoabdominal cancer who underwent elective major thoracoabdominal surgeries. Materials and Methods: A retrospective observational cohort study was conducted on cancer patients that underwent pre-operative CPET at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, from September 2017 to September 2019. All adult male and female patients with a significant medical history for cancer of the thoracoabdominal region who underwent CPET before a major thoracoabdominal surgery were included in the study. Results: A total of 32 patients were included in the present investigation. The mean age of the sample was 62.75 ± 10.18 years, and the majority of the participants were female. Following surgery, 53% of the participants had post-operative complications in terms of morbidity and mortality. Fifteen participants had an anaerobic threshold (AT) of ≥11.0 ml/ kg/min. Among these, 12 participants had an uneventful surgery. On the contrary, among 17 participants that were considered to have a high risk (<11.0 ml/kg/min) for surgery, 14 subjects (82%) had at least one complication (including mortality). The sensitivity and specificity of CPET to anticipate complications during oncological surgery were calculated to be 82% and 80%, respectively. The mean AT of participants with uneventful surgery was calculated to be 11.83 ± 1.01 ml/kg/min. This was statistically greater than the AT of subjects that had morbidity (9.86 ± 1.20 ml/kg/min) or mortality (8.95 ± 0.35 ml/kg/min) (< 0.001). Conclusion: CPET, when using AT alone as an indicator, can provide a good-excellent prediction of perioperative outcome among oncology patients undergoing major thoracoabdominal surgical procedures.

Published
2021-01-11
How to Cite
1.
Sadaqat S, Khan AW, Ashfaq AD, Rehman SU. Role of Cardiopulmonary Exercise Testing in Predicting Perioperative Outcomes in Cancer Patients Undergoing Thoracoabdominal Surgeries; an Observational Cohort Study. J Cancer Allied Spec [Internet]. 2021Jan.11 [cited 2021Apr.17];7(1). Available from: https://journals.sfu.ca/jcas/index.php/jcas/article/view/313
Section
Original Research Article