Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus

J Thorac Cardiovasc Surg. 2001 Jun;121(6):1064-8. doi: 10.1067/mtc.2001.113596.


Objective: We evaluated the usefulness of analyzing expired gas during exercise testing for the prediction of postoperative cardiopulmonary complications in patients with esophageal carcinoma.

Background data: Radical esophagectomy with 3-field lymphadenectomy is performed in patients with thoracic esophageal carcinoma but has a high risk of postoperative complications. To reduce the surgical risk, we performed preoperative risk analysis using 8 factors. Although hospital mortality was decreased when this risk analysis was used, severe cardiopulmonary complications still occurred.

Methods: The study group consisted of 91 patients who had undergone curative esophagectomy with 3-field lymphadenectomy. The maximum oxygen uptake, anaerobic threshold, vital capacity, percent vital capacity, forced expiratory volume in 1 second, percent forced expiratory volume, V.(25)/HT, forced expired flow at 75% of forced vital capacity to height ratio (FEF(75%)/HT), forced expired flow at 50% to 75% of forced vital capacity ratio (FEF(50%)/FEF(75%)), percent diffusion capacity for carbon monoxide, and arterial oxygen tension were measured. Patients were divided into 2 groups on the basis of the presence or absence of postoperative cardiopulmonary complications.

Results: Only the maximum oxygen uptake was significantly different between the 2 groups. All patients were grouped according to the value of the maximum oxygen uptake, and the occurrence of postoperative cardiopulmonary complications was calculated for each group. A cardiopulmonary complication rate of 86% was found for patients with a maximum oxygen uptake of less than 699 mL. min(-1). m(-2); for those with a value of 700 to 799 mL. min(-1). m(-2), the complication rate was 44%.

Conclusions: The maximum oxygen uptake obtained by expired gas analysis during exercise testing correlates with the postoperative cardiopulmonary complication rate. On the basis of these results, esophagectomy with 3-field lymphadenectomy can be safely performed in patients with a maximum oxygen uptake of at least 800 mL. min(-1). m(-2).

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Blood Gas Analysis
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / physiopathology*
  • Carcinoma, Squamous Cell / surgery*
  • Esophageal Neoplasms / diagnosis
  • Esophageal Neoplasms / physiopathology*
  • Esophageal Neoplasms / surgery*
  • Esophagectomy / adverse effects
  • Esophagectomy / methods
  • Exercise Test*
  • Female
  • Heart Diseases / diagnosis
  • Heart Diseases / etiology
  • Humans
  • Inspiratory Reserve Volume*
  • Logistic Models
  • Lung Diseases / diagnosis
  • Lung Diseases / etiology
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis
  • Predictive Value of Tests
  • Preoperative Care
  • Respiratory Function Tests
  • Risk Assessment
  • Sensitivity and Specificity
  • Statistics, Nonparametric
  • Thoracotomy