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Improved Risk Stratification Prior to Major Pulmonary Resection by Combining Peak Oxygen Uptake and Ventilatory
Karolina Kristenson1, Johan Hylander2, Miklós Boros1
1Department of Cardiothoracic and Vascular Surgery in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
CHEST Pulmonary
|August 4, 2026
Summary
Combining cardiopulmonary exercise testing (CPET) variables improves risk assessment for lung cancer surgery patients. A new 9-field matrix using peak oxygen uptake and ventilatory efficiency effectively identifies those at risk of complications or death.
Area of Science:
- Cardiology
- Pulmonology
- Thoracic Surgery
- Oncology
Background:
- Cardiopulmonary exercise testing (CPET) is crucial for preoperative evaluation in lung cancer surgery.
- Evolving surgical and diagnostic practices necessitate reevaluation of CPET's role.
- Optimizing CPET interpretation can enhance patient risk stratification.
Purpose of the Study:
- To determine if combining two CPET variables can improve risk assessment for lung cancer surgery.
- To evaluate the utility of optimal threshold values for peak oxygen uptake and ventilatory efficiency.
- To develop a refined risk assessment tool for predicting postoperative complications.
Main Methods:
- Retrospective analysis of 208 lung cancer patients undergoing preoperative CPET (2008-2020).
- Combined percent predicted peak oxygen uptake (Vo2peak) and minute ventilation/carbon dioxide elimination slope (VE/VCO2 slope) using sensitive thresholds.
- Developed a 9-field risk assessment matrix and compared complication rates using chi-squared test.
Main Results:
- A 9-field matrix based on Vo2peak and VE/VCO2 slope showed significant differences in major pulmonary complications (MPC) or death (P < .001).
- Patients with favorable Vo2peak and VE/VCO2 slope had no MPC or death.
- Worsening values in both parameters correlated with increased adverse outcomes.
Conclusions:
- A 9-field matrix combining Vo2peak and VE/VCO2 slope demonstrates a synergistic effect in predicting MPC or death after lung cancer surgery.
- This matrix enhances risk assessment accuracy for patients undergoing lobectomy or pulmectomy.
- The findings support refining CPET-based risk stratification in lung cancer patients.