Cardiopulmonary exercise testing as a screening test for perioperative management of major cancer surgery: a pilot study

Introduction

Cardiopulmonary exercise testing is an important screening test to evaluate cardiorespiratory function before major body cavity surgery.

Objective

To develop a clinical strategy for the identification and management of high-risk major cancer surgical patients in order to reduce perioperative morbidity and mortality.

Methods

Forty-one major cancer surgery patients underwent a cardiopulmonary exercise test (CPX) as part of their preoperative assessment. Their cardiac and pulmonary risk factors were analysed. Depending on the anaerobic threshold (AT) values, patients are considered poor risk, moderate risk or very low risk for surgery.

Results

Three patients did not complete the test. Two of them had very poor cardiopulmonary reserve and one had leg fatigue with good pulmonary function. Seven patients were considered high risk with AT < 10. The remaining 31 patients had AT > 11 and underwent major cancer surgery. In total, 10 surgical procedures were cancelled based on poor CPX performance. Two patients with low AT underwent surgery after preoptimisation with no complications. There are no deaths related to cardiopulmonary complications in any patient deemed fit for major cancer surgery and intensive care management, as determined by CPX testing. The average intensive care stay was 8.9 days (range 1–19 days). The surgical procedure was altered in two patients based on CPX results.

Discussion

CPX testing is an important screening test for major surgery to determine the cardiorespiratory risk factors. It is useful in reducing surgical perioperative mortality and avoids unnecessary intensive care admissions after major body cavity surgeries. The CPX test is also useful in perioperative anaesthetic management. It may not predict morbidity and the average intensive care stay. It is very useful in selecting patients for preoptimisation before major cancer surgery.

Conclusion

Preoperative screening using CPX testing is useful in identification of high-risk cancer surgical patients and the appropriate selection of perioperative management.