Peak Workload as Predictor of Respiratory Complications in Patients Undergoing Resection for Lung Cancer

To determine whether peak workload (Wpeak), expressed as a percentage of predicted value during a cardiopulmonary exercise test (CPET), can predict postoperative cardiopulmonary complications in high-risk patients undergoing lung cancer resection.

A retrospective cohort study was conducted on 226 consecutive patients who underwent anatomical lung resection (lobectomy or segmentectomy) for non-small cell lung cancer between 2013 and 2017. All patients were considered high risk, with preoperative FEV₁ and DLco <80% predicted and underwent full CPET within 30 days prior to surgery. The main endpoint was the occurrence of cardiopulmonary complications within 30 days postoperatively. The predictive ability of Wpeak (% predicted) for complications was evaluated using ROC analysis and optimal cutoff was identified. Outcomes were compared above and below this threshold.

A Wpeak threshold of 52% predicted was identified as the optimal cutoff, with an area under the ROC curve of 0.59 (95% CI: 0.51-0.67; p = 0.015). Patients with Wpeak ≤52% had a significantly higher rate of postoperative complications (58% vs. 33%, p = 0.001), particularly respiratory complications (47% vs. 28%, p = 0.008), and longer hospital stays (mean 24 vs. 15 days, p = 0.002). They also had lower FEV₁, DLco, VO₂peak, and heart rate responses compared to patients with Wpeak >52%.

Wpeak ≤52% of predicted was associated with increased risk of postoperative complications and longer hospitalization. Although the discriminatory ability was modest (AUC 0.59), Wpeak ≤52% predicted was associated with higher postoperative complications and may serve as a complementary tool for risk stratification, especially in resource-limited settings. Further prospective validation is warranted.