Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery

Br J Surg. 2014 Aug;101(9):1166-72. doi: 10.1002/bjs.9551. Epub 2014 Jun 11.


Background: This study investigated the relationship between objectively measured physical fitness variables derived by cardiopulmonary exercise testing (CPET) and in-hospital morbidity after rectal cancer surgery.

Methods: Patients scheduled for rectal cancer surgery underwent preoperative CPET (reported blind to patient characteristics) with recording of morbidity (recorded blind to CPET variables). Non-parametric receiver operating characteristic (ROC) curves and logistic regression were used to assess the relationship between CPET variables and postoperative morbidity.

Results: Of 105 patients assessed, 95 (72 men) were included; ten patients had no surgery and were excluded (3 by choice, 7 owing to unresectable metastasis). Sixty-eight patients had received neoadjuvant treatment. ROC curve analysis of oxygen uptake (V˙o2 ) at estimated lactate threshold (θ^L ) and peak V˙o2 gave an area under the ROC curve of 0·87 (95 per cent confidence interval 0·78 to 0·95; P < 0·001) and 0·85 (0·77 to 0·93; P < 0·001) respectively, indicating that they can help discriminate patients at risk of postoperative morbidity. The optimal cut-off points identified were 10·6 and 18·6 ml per kg per min for V˙o2 at θ^L and peak respectively.

Conclusion: CPET can help predict morbidity after rectal cancer surgery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Exercise Test / methods*
  • Female
  • Humans
  • Length of Stay
  • Male
  • Neoadjuvant Therapy
  • Oxygen Consumption / physiology
  • Physical Fitness / physiology*
  • Postoperative Complications / etiology*
  • Postoperative Complications / physiopathology
  • Preoperative Care / methods
  • ROC Curve
  • Rectal Neoplasms / physiopathology
  • Rectal Neoplasms / surgery*
  • Reoperation / statistics & numerical data
  • Risk Assessment
  • Treatment Outcome