Cardiopulmonary exercise testing for preoperative risk assessment before hepatic resection

Area of Science:

• Hepatobiliary surgery
• Cardiopulmonary exercise physiology
• Surgical risk assessment

Background:

• Assessing operative risk is crucial in liver surgery, especially for elderly patients with comorbidities.
• Preoperative cardiopulmonary exercise testing (CPET) is evaluated for high-risk hepatic resection candidates.

Purpose of the Study:

• To evaluate the utility of preoperative CPET in assessing operative risk for patients undergoing liver resection.
• To identify specific CPET parameters predictive of mortality and complications.

Main Methods:

• A prospective cohort of liver resection candidates, aged over 65 or younger with comorbidities, underwent preoperative CPET.
• Functional status, postoperative complications, and survival data were prospectively collected.

Main Results:

• An anaerobic threshold (AT) below 9.9 ml O(2)/kg/min predicted in-hospital death and worse long-term survival (HR 1.81).
• VE/VCO(2) at AT predicted postoperative complications, with a threshold of 34.5 showing 84% specificity.
• No in-hospital deaths occurred in patients with an AT above 9.9 ml O(2)/kg/min.

Conclusions:

• CPET is a valuable prognostic tool for preoperative assessment in liver resection.
• Specific CPET parameters like AT and VE/VCO(2) offer significant predictive value for patient outcomes.