Cardiopulmonary fitness before and after neoadjuvant chemotherapy in patients with oesophagogastric cancer

Background Neoadjuvant chemotherapy may have a detrimental impact on cardiorespiratory reserve. Determination of oxygen uptake at the anaerobic threshold by cardiopulmonary exercise testing (CPET) provides an objective measure of cardiorespiratory reserve. Anaerobic threshold can be used to predict...

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Bibliographic Details
Published in:British journal of surgery 2018-06, Vol.105 (7), p.900-906
Main Authors: Navidi, M., Phillips, A. W., Griffin, S. M., Duffield, K. E., Greystoke, A., Sumpter, K., Sinclair, R. C. F.
Format: Article
Language:English
Subjects:
Adenocarcinoma - drug therapy
Adenocarcinoma - physiopathology
Adenocarcinoma - surgery
Adult
Aged
Aged, 80 and over
Anaerobic Threshold
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Cardiorespiratory Fitness
Chemotherapy, Adjuvant
Esophageal Neoplasms - drug therapy
Esophageal Neoplasms - physiopathology
Esophageal Neoplasms - surgery
Esophagectomy
Exercise Test
Feasibility Studies
Female
Gastrectomy
Humans
Male
Middle Aged
Neoadjuvant Therapy
Oxygen Consumption
Prospective Studies
Stomach Neoplasms - drug therapy
Stomach Neoplasms - physiopathology
Stomach Neoplasms - surgery
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Summary:Background Neoadjuvant chemotherapy may have a detrimental impact on cardiorespiratory reserve. Determination of oxygen uptake at the anaerobic threshold by cardiopulmonary exercise testing (CPET) provides an objective measure of cardiorespiratory reserve. Anaerobic threshold can be used to predict perioperative risk. A low anaerobic threshold is associated with increased morbidity after oesophagogastrectomy. The aim of this study was to establish whether neoadjuvant chemotherapy has an adverse effect on fitness, and whether there is recovery of fitness before surgery for oesophageal and gastric adenocarcinoma. Methods CPET was completed before, immediately after (week 0), and at 2 and 4 weeks after neoadjuvant chemotherapy. The ventilatory anaerobic threshold and peak oxygen uptake (Vo2 peak) were used as objective, reproducible measures of cardiorespiratory reserve. Anaerobic threshold and Vo2 peak were compared before and after neoadjuvant chemotherapy, and at the three time intervals. Results Some 31 patients were recruited. The mean anaerobic threshold was lower following neoadjuvant treatment: 15·3 ml per kg per min before chemotherapy versus 11·8, 12·1 and 12·6 ml per kg per min at week 0, 2 and 4 respectively (P 
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.10802