Cardiopulmonary exercise variables and their association with postoperative morbidity and mortality after major oesophagogastric cancer surgery—a multicentre observational study
Malcolm A. West,
Saqib Rahman,
Sandy Jack,
Michael P.W. Grocott,
Denny Z.H. Levett,
Yasir Rashid,
John Griffiths,
Martin Ezra,
Lyndsay Ayres,
Helen Neville-Webbe,
Muhammad Shafiq Javed,
Milind Shrotri,
Iftikhar Khan,
David Whitmore,
Pradeep Prabhu,
David Timbrell,
Sophie Allen,
Andrew O. Packham,
David Sharpe,
Helen Anderson,
Gary Minto,
Samuel McAleer,
Stuart McPhail,
Mohamed Alasmar,
Robert A. Hartley,
Javed Sultan,
Ben Grace,
Timothy J. Underwood,
James Byrne,
Fergus Noble,
Jamie Kelly,
Gillian Ansell,
Mark Edwards
Affiliations
Malcolm A. West
School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK; Corresponding author. School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.
Saqib Rahman
School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
Sandy Jack
Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
Michael P.W. Grocott
Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
Denny Z.H. Levett
Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
Yasir Rashid
Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
John Griffiths
Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
Martin Ezra
Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
Lyndsay Ayres
Departments of Anaesthesia and Critical Care, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
Helen Neville-Webbe
Departments of Anaesthesia and Critical Care, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Department of General Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
Muhammad Shafiq Javed
Department of General Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
Milind Shrotri
Department of General Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
Iftikhar Khan
Department of General Surgery, Aintree University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
David Whitmore
Departments of Anaesthesia and Critical Care, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Countess of Chester Hospital NHS Foundation Trust, Chester, UK
Pradeep Prabhu
Department of Anaesthetics, The Royal Surrey Foundation NHS Trust, Guildford, UK
David Timbrell
Department of Anaesthetics, The Royal Surrey Foundation NHS Trust, Guildford, UK; Anaesthetic Department, Frimley Park Hospital, Frimley Health NHS Foundation Trust, UK
Sophie Allen
Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Minimal Access Therapy Training Unit (MATTU), Guildford, UK
Andrew O. Packham
Department of Anaesthesia, University Hospitals of Leicester NHS Trust, Leicester, UK
David Sharpe
Department of Gastro-Intestinal Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
Helen Anderson
Directorate of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, UK
Gary Minto
Directorate of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, UK
Samuel McAleer
Directorate of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, UK; Emergency Medical Retrieval and Transfer Service, Cymru, Joint Hospital Group (Southwest), UK
Stuart McPhail
Directorate of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, UK; Institute of Naval Medicine, Alverstoke, UK
Mohamed Alasmar
Salford Royal NHS Foundation Trust, Salford Royal, Salford, UK; Division of Cancer Sciences, School of Medical Sciences, University of Manchester, UK
Robert A. Hartley
Salford Royal NHS Foundation Trust, Salford Royal, Salford, UK; Division of Cancer Sciences, School of Medical Sciences, University of Manchester, UK
Javed Sultan
Department of General Surgery, The Royal Surrey NHS Foundation Trust Hospital, Minimal Access Therapy Training Unit (MATTU), Guildford, UK; Salford Royal NHS Foundation Trust, Salford Royal, Salford, UK; Division of Cancer Sciences, School of Medical Sciences, University of Manchester, UK
Ben Grace
School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
Timothy J. Underwood
School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK; University Hospitals Southampton, Department of Surgery, Southampton, UK
James Byrne
University Hospitals Southampton, Department of Surgery, Southampton, UK
Fergus Noble
University Hospitals Southampton, Department of Surgery, Southampton, UK
Jamie Kelly
University Hospitals Southampton, Department of Surgery, Southampton, UK
Gillian Ansell
Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; University Hospitals Southampton, Department of Surgery, Southampton, UK
Mark Edwards
Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton, UK; Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; University Hospitals Southampton, Department of Surgery, Southampton, UK
Background: 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. Methods: 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. Results: 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<0.001) and Clavien–Dindo ≥3a (P<0.001) were associated with 1-yr and 3-yr survival. On subgroup analyses, pre-neoadjuvant treatment CPET; anaerobic threshold (absolute; P=0.024, relative to ideal body weight; P=0.001, body surface area; P=0.009) and VE/VCO2 at anaerobic threshold (P=0.026) were associated with 3-yr survival. No other CPET variables (pre- or post-neoadjuvant treatment) were associated with survival. Conclusions: VO2 peak was not associated with 1-yr survival after oesophagogastric cancer resection. Tumour characteristics and major complications were associated with survival; however, only some selected pre-neoadjuvant treatment CPET variables were associated with 3-yr survival. CPET in this cohort of patients demonstrates limited outcome predictive precision. Clinical trial registration: NCT03637647.
