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Does Cardiopulmonary Testing Help Predict Long-Term Survival After Esophagectomy?
Jakub Chmelo1, Rachel A Khaw1, Rhona C F Sinclair2
1Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
Annals of Surgical Oncology
|May 27, 2021
Summary
Cardiopulmonary exercise testing (CPET) can predict long-term survival after esophagectomy. A high ventilatory equivalent for carbon dioxide (VE/VCO2) at the anaerobic threshold is an independent predictor of survival in esophageal cancer patients.
Area of Science:
- Cardiology
- Thoracic Surgery
- Oncology
Background:
- Esophagectomy carries significant morbidity and mortality risks.
- Preoperative cardiopulmonary fitness is linked to surgical outcomes.
- The association between cardiorespiratory fitness and long-term survival after esophagectomy remains unclear.
Purpose of the Study:
- To determine if cardiopulmonary exercise testing (CPET) variables predict long-term survival in esophageal cancer patients undergoing esophagectomy.
- To identify specific CPET metrics associated with improved patient outcomes.
Main Methods:
- Retrospective analysis of 313 patients undergoing trans-thoracic esophagectomy for esophageal cancer.
- Utilized Cox proportional hazard models to assess the relationship between CPET variables and survival.
- Performed Receiver Operating Characteristic (ROC) analysis to identify predictive cutoff values for 3-year survival.
Main Results:
- The ventilatory equivalent for carbon dioxide (VE/VCO2) at the anaerobic threshold was the sole CPET variable independently predicting long-term survival (HR, 1.049; p=0.011).
- Pathologic stages 3 and 4 disease also independently predicted survival.
- ROC analysis did not identify a predictive cutoff value for 3-year survival based on VE/VCO2 (AUC, 0.564; p=0.056).
Conclusions:
- Elevated pre-esophagectomy VE/VCO2 is an independent predictor of long-term survival in patients with malignant esophageal disease.
- VE/VCO2 may serve as a crucial variable for clinicians when discussing prognosis with patients.
- Further research may refine the use of CPET in optimizing surgical decision-making and patient counseling.
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