Cardiopulmonary Exercise Testing as a Predictor of Postoperative Outcome in Patients Undergoing Oesophageal Cancer Surgery Following Neoadjuvant Chemotherapy

Objective: Neoadjuvant chemotherapy improves resectability rates of oesophageal cancer, but the process may also take a toll on the patients’ exercise capacity and may adversely affect the postoperative outcomes. It can be assessed objectively using cardiopulmonary exercise testing. Methods: Patients with oesophagus cancer performed a baseline test and a second test after neoadjuvant chemotherapy during the week preceding oesophagectomy. They were followed up for postoperative complications, length of hospital stay, and 30-day mortality. Results: Thirty-three patients completed the study. The mean pre-chemotherapy peak oxygen uptake (VO₂ peak) was 1128.39 ± 202.79 mL min⁻¹ (19.46 ± 3.06 mL kg⁻¹ min⁻¹) which declined to 1010.33 ± 195.56 mL min⁻¹ (17.24 ± 2.55 mL kg⁻¹ min⁻¹) in the post-chemotherapy period (P < .001). Pre-chemotherapy anaerobic threshold was 906.85 ± 176.81 mL min⁻¹ (15.54 ± 2.24 mL kg⁻¹ min⁻¹) which declined to 764.76 ± 158.79 mL min⁻¹ (13.01 ± 2.22 mL kg⁻¹ min⁻¹) (P < .001) in the post-chemotherapy period. Six patients developed complications of modified Clavien–Dindo grade 3 and above. Two (6.1%) patients succumbed to complications within 30 days. The mean anaerobic threshold in patients who suffered complications modified Clavien–Dindo grade ≥3 was 693.33 ± 140.99 mL min⁻¹ (11.2 ± 1.17 mL kg⁻¹ min⁻¹) while patients with mild to moderate complications had a mean anaerobic threshold 13.41 ± 2.21 mL kg⁻¹ min⁻¹ (P < .006). An optimal cut off value for anaerobic threshold was 12.5 mL kg⁻¹ min⁻¹. Conclusion: Cardiopulmonary exercise testing accurately predicts outcomes in cancer oesophagus patients who undergo neoadjuvant chemotherapy followed by surgery.