Cardiopulmonary exercise variables and their association with postoperative morbidity and mortality after major oesophagogastric cancer surgery—a multicentre observational study

• Published in: BJA open 2024-06, Vol.10, p.100289, Article 100289
• Main Authors: West, Malcolm A., Rahman, Saqib, Jack, Sandy, Grocott, Michael P.W., Levett, Denny Z.H., Rashid, Yasir, Griffiths, John, Ezra, Martin, Ayres, Lyndsay, Neville-Webbe, Helen, Javed, Muhammad Shafiq, Shrotri, Milind, Khan, Iftikhar, Whitmore, David, Prabhu, Pradeep, Timbrell, David, Allen, Sophie, Packham, Andrew O., Sharpe, David, Anderson, Helen, Minto, Gary, McAleer, Samuel, McPhail, Stuart, Alasmar, Mohamed, Hartley, Robert A., Sultan, Javed, Grace, Ben, Underwood, Timothy J., Byrne, James, Noble, Fergus, Kelly, Jamie, Ansell, Gillian, Edwards, Mark
• Format: Article
• Language: English
• Subjects: cardiopulmonary exercise testing; fitness; morbidity; mortality; neoadjuvant cancer treatments; oesophagogastric cancer; tumour outcomes
• ISSN: 2772-6096; 2772-6096
• DOI: 10.1016/j.bjao.2024.100289

Outcomes after oesophagogastric cancer surgery remain poor. Cardiopulmonary exercise testing (CPET) used for risk stratification before oesophagogastric cancer surgery is based on conflicting evidence. This study explores the relationship between CPET and postoperative outcomes, specifically for patients undergoing neoadjuvant treatment. Patients undergoing oesophagogastric cancer resection and CPET (pre- or post-neoadjuvant treatment, or both) were retrospectively enrolled into a multicentre pooled cohort study. Oxygen uptake at peak exercise (VO2 peak) was compared with 1-yr postoperative survival. Secondary analyses explored relationships between patient characteristics, tumour pathology characteristics, CPET variables (absolute, relative to weight, ideal body weight, and body surface area), and postoperative outcomes (morbidity, 1-yr and 3-yr survival) were assessed using logistic regression analyses. Seven UK centres recruited 611 patients completing a 3-yr postoperative follow-up period. Oesophagectomy was undertaken in 475 patients (78%). Major complications occurred in 25%, with 18% 1-yr and 43% 3-yr mortality. No association between VO2 peak or other selected CPET variables and 1-yr survival was observed in the overall cohort. In the overall cohort, the anaerobic threshold relative to ideal body weight was associated with 3-yr survival (P=0.013). Tumour characteristics (ypT/ypN/tumour regression/lymphovascular invasion/resection margin; P