癌症胰十二指肠切除术前心肺运动试验用于术前风险评估。

Cardiopulmonary exercise testing for preoperative risk assessment before pancreaticoduodenectomy for cancer.

作者信息

Junejo M A, Mason J M, Sheen A J, Bryan A, Moore J, Foster P, Atkinson D, Parker M J, Siriwardena A K

机构信息

Hepato-Pancreato-Biliary Surgery Unit, Manchester Royal Infirmary, Manchester, UK.

出版信息

Ann Surg Oncol. 2014 Jun;21(6):1929-36. doi: 10.1245/s10434-014-3493-0. Epub 2014 Jan 30.

DOI:10.1245/s10434-014-3493-0

PMID:24477709

Abstract

OBJECTIVE

Pancreaticoduodenectomy is the standard of care for tumors confined to the head of pancreas and can be undertaken with low operative mortality. The procedure has a high morbidity, particularly in older patient populations with preexisting comorbidities. This study evaluated the role of cardiopulmonary exercise testing to predict postoperative morbidity and outcome in high-risk patients undergoing pancreaticoduodenectomy.

METHODS

In a prospective cohort of consecutive patients undergoing pancreaticoduodenectomy, those aged over 65 years (or younger with comorbidity) were categorized as high risk and underwent preoperative assessment by cardiopulmonary exercise testing (CPET) according to a predefined protocol. Data were collected on functional status, postoperative complications, and survival.

RESULTS

A total of 143 patients underwent preoperative assessment, 50 of whom were deemed to be at low risk for surgery per study protocol. Of 93 high-risk patients, 64 proceeded to surgery after preoperative CPET. Neither anaerobic threshold (AT) nor maximal oxygen consumption ([Formula: see text] O 2 MAX) predicted patient mortality or morbidity. However, ventilatory equivalent of carbon dioxide ([Formula: see text] E/[Formula: see text] CO 2) at AT was a predictive marker of postoperative mortality, with an area under the curve (AUC) of 0.84 (95 % confidence interval [CI] 0.63-1.00, p = 0.020); a threshold of 41 was 75 % sensitive and 95 % specific (positive predictive value 50 %, negative predictive value 98 %). Above this threshold, raised [Formula: see text] E/[Formula: see text] CO 2 predicted poor long-term survival (hazard ratio 2.05, 95 % CI 1.09-3.86, p = 0.026).

CONCLUSIONS

CPET is a useful adjunctive test for predicting postoperative outcome in patients being assessed for pancreaticoduodenectomy. Raised CPET-derived [Formula: see text] E/[Formula: see text] CO 2 predicts early postoperative death and poor long-term survival.

摘要

目的

胰十二指肠切除术是治疗局限于胰头肿瘤的标准术式，手术死亡率较低。但该手术并发症发生率较高，尤其是在伴有基础疾病的老年患者中。本研究评估心肺运动试验在预测接受胰十二指肠切除术的高危患者术后并发症及预后中的作用。

方法

在一个连续接受胰十二指肠切除术患者的前瞻性队列研究中，年龄超过65岁（或有合并症的较年轻患者）被归类为高危患者，并根据预定义方案接受心肺运动试验（CPET）术前评估。收集患者功能状态、术后并发症及生存情况的数据。

结果

共有143例患者接受了术前评估，其中50例根据研究方案被认为手术风险较低。在93例高危患者中，64例在术前CPET后接受了手术。无氧阈（AT）和最大摄氧量（[公式：见原文] O₂MAX）均不能预测患者的死亡率或并发症发生率。然而，AT时的二氧化碳通气当量（[公式：见原文] E/[公式：见原文] CO₂）是术后死亡率的预测指标，曲线下面积（AUC）为0.84（95%置信区间[CI] 0.63 - 1.00，p = 0.020）；阈值为41时，敏感性为75%，特异性为95%（阳性预测值50%，阴性预测值98%）。高于此阈值时，升高的[公式：见原文] E/[公式：见原文] CO₂预示长期生存不良（风险比2.05，95% CI 1.09 - 3.86，p = 0.026）。