Exercise testing and postoperative complications after minimally invasive lung resection: A cohort study

Area of Science:

• Cardiology
• Thoracic Surgery
• Pulmonology

Background:

• Peak oxygen uptake (VO2 max) is crucial for risk stratification in lung cancer surgery.
• Existing thresholds for VO2 max were primarily established from thoracotomy procedures.
• The applicability of VO2 max in minimally invasive VATS requires further investigation.

Purpose of the Study:

• To assess the predictive value of peak oxygen uptake (VO2 max) and other cardiorespiratory exercise testing (CPET) variables for postoperative outcomes.
• To evaluate these predictors specifically in patients undergoing video-assisted thoracoscopic surgery (VATS) for lung cancer resection.

Main Methods:

• Retrospective analysis of 593 patients who underwent VATS lung resection and CPET.
• Logistic regression models identified predictors of 30-day postoperative mortality and morbidity.
• Receiver operating characteristic (ROC) analysis assessed the discriminatory ability of peak VO2 max.

Main Results:

• Postoperative cardiopulmonary complications occurred in 15.5% of patients, with 3 deaths.
• Key predictors of complications included peripheral arterial disease, extent of resection (bilobectomy/pneumonectomy), preoperative FEV1, and peak VO2.
• Patients with peak VO2 < 15 mL·kg−1·min−1 had a 23.8% complication rate, compared to 10.4% for those with peak VO2 ≥ 20 mL·kg−1·min−1.
• The ROC analysis showed a limited discriminatory ability for peak VO2 (Area Under Curve = 0.63).

Conclusions:

• Lower peak oxygen uptake (VO2 max) is a significant predictor of postoperative complications after VATS lung cancer resection.
• However, the predictive performance of peak VO2 for discriminating between patients with and without complications is limited.
• These findings suggest that while VO2 max is a relevant factor, additional or refined parameters may be necessary for precise risk stratification in VATS procedures.