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Clinical Investigations: SURGERY |

Cardiopulmonary Exercise Tests and Lung Cancer Surgical Outcome*

Thida Win, MRCP; Arlene Jackson; Linda Sharples, PhD; Ashley M. Groves, MRCP; Francis C. Wells, FRCS; Andrew J. Ritchie, FRCS; Clare M. Laroche, FRCP
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*From Thoracic Oncology Unit (Drs. Win and Laroche), Respiratory Physiology Department (Ms. Jackson), and Cardiothoracic Surgery Departments (Drs. Wells and Ritchie), Papworth Hospital, Papworth; MRC Biostatistics Unit (Dr. Sharples); and Department of Radiology and Nuclear Medicine (Dr. Groves), Addenbrooke’s Hospital, Cambridge, UK.

Correspondence to: Thida Win, MRCP, Consultant Chest Physician, Thoracic Oncology Unit, Papworth Hospital, Papworth Everard, Cambridge, CB3 8RE, UK; e-mail: thida.win@papworth.nhs.uk



Chest. 2005;127(4):1159-1165. doi:10.1378/chest.127.4.1159
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Study objectives: Surgical resection remains the treatment of choice for anatomically resectable non-small cell lung cancer. However, the presence of associated comorbid conditions increases the risk of death and surgical complications. Several studies have evaluated the usefulness of preoperative exercise testing for predicting postoperative morbidity and mortality. The aim of this study was to establish whether exercise testing could predict poor surgical outcome in lung cancer surgery and whether the absolute value or percentage of predicted value is the better predictor of the surgical outcome.

Design: The study was designed as a prospective study.

Patients and setting: One hundred thirty patients with potentially operable lung cancer at Papworth Hospital over 2 years were recruited; of these, 101 underwent curative surgery.

Interventions: Spirometry and cardiopulmonary exercise tests were performed for every patient (n = 99), except for two patients with back problems. We also recorded the outcome of surgery, in particular, complications and mortality.

Measurements and results: Mean maximum oxygen transport at peak exercise (V̇o2peak) was 18.3 mL/kg/min (SD, 4.7 mL/kg/min), and mean percentage of predicted V̇o2peak value was 84.4% (SD, 30%). Poor surgical outcome was significantly related to V̇o2peak percentage of predicted (p < 0.01) but not to the actual oxygen uptake value.

Conclusions: The use of the percentage of predicted V̇o2peak value would be a better indicator of surgical outcome, since it predicts the surgical outcome better, and corrects for normal physiologic ranges. The threshold of V̇o2peak for surgical intervention could be set between 50% and 60% of predicted without excess surgical mortality.

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