Cardiopulmonary Exercise Testing in Oesophagogastric Surgery: a Systematic Review
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REVIEW ARTICLE
Cardiopulmonary Exercise Testing in Oesophagogastric Surgery: a Systematic Review G. Sheill 1
&
S. Reynolds 1 & L. O’Neill 1 & D. Mockler 2 & J. V. Reynolds 3 & J. Hussey 1 & E. Guinan 4
Received: 14 April 2020 / Accepted: 7 June 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Cardiopulmonary exercise testing (CPX) can objectively measure fitness and oxygen uptake at anaerobic threshold. The relationship between fitness and postoperative outcomes after upper gastro-intestinal surgery is unclear. The aim of the present review is to assess the prognostic ability of CPX in predicting postoperative outcome associated with oesophagogastric surgery. Methods Relevant studies were identified through a systematic search of EMBASE, Medline, CINAHL, Cochrane Library, and Web of Science to July 2019. The eligibility criteria for studies included prognostic studies of upper gastro-intestinal surgery among adult populations using a preoperative CPX and measurement of postoperative outcome (mortality or morbidity or length of stay). Risk of bias was assessed using the QUIPS Quality in Prognostic Studies validated tool. Results Thirteen papers with a total of 1735 participants were included in data extraction. A total of 7 studies examined the association between CPX variables and postoperative mortality. Patients undergoing gastro-intestinal surgery with lower anaerobic threshold values were found to have an increased risk of postoperative mortality. Similarly, a lower rate of oxygen consumption was found to be associated with higher mortality. There was conflicting evidence regarding the association between CPX variables and postoperative morbidity. The evidence did not demonstrate any association between preoperative CPX variables and hospital length of stay. Conclusion Studies report an association between CPX variables and postoperative mortality; however, there is conflicting evidence regarding the association between CPX variables and postoperative morbidity. Keywords Exercise test . Cardiopulmonary exercise testing . Perioperative medicine
Introduction Surgical intervention remains the primary curative intervention in early-stage oesophageal cancer. It also remains the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-020-04696-2) contains supplementary material, which is available to authorized users. * G. Sheill [email protected] 1
Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
2
Medical Library, Trinity College Dublin, Dublin, Ireland
3
Department of Surgery, Trinity College Dublin and St. James’s Hospital, Dublin, Ireland
4
School of Medicine, Trinity College, The University of Dublin, Dublin, Ireland
key modality for local control in locally advanced disease, usually in combination with preoperative chemoradiation, or pre- and postoperative chemotherapy.1,2 Overall survival rates after oesophagectomy have been improving in recent years due to the centralisation of these
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