Marjanski Tomasz, Wnuk Damian, Bosakowski Damian, Szmuda Tomasz, Sawicka Wioletta, Rzyman Witold
Thoracic Surgery Department, Medical University of Gdansk, Gdansk, Poland
Department of Physiotherapy, Medical University of Gdansk, Gdansk, Poland.
Eur J Cardiothorac Surg. 2015 May;47(5):e213-9. doi: 10.1093/ejcts/ezv049. Epub 2015 Feb 26.
Exercise testing is an additional tool to standard pulmonary assessment before radical pulmonary resection in lung cancer patients. Evidence is lacking, supporting the significance of routine implementation of these simple physiological tests in preoperative evaluation.
Between April 2009 and October 2011, 253 lung cancer patients, who underwent lobectomy in a single institution, were entered into this study. All of the patients were accepted for resection based on a standard evaluation protocol. Additionally on the day before the surgery, patients performed a 6-min walk test (6MWT). Patients were categorized, depending on the result of 6MWT, in order to stratify their risk of postoperative complications. Threshold values of 6MWT were assessed on the basis of maximum area under ROC curves.
There were 148 men and 105 women with a mean age of 63 years. All patients underwent lobectomies due to primary lung cancer. A distance of 500 m and 100% of the predicted 6MWT were taken as threshold values differentiating risk of postoperative complications. The cut-off value of 500 m separates individuals with an increased risk of postoperative complications [60.6 vs 36.9%, odds ratio (OR): 2631; 95% confidence interval (CI): 1.423-4.880] and prolonged hospitalization (7 vs 6 days). By applying a cut-off value of 500 m, the higher incidence of atrial fibrillation (21.2 vs 11.7%; OR: 2019; 95% CI: 0.904-4.484) and higher requirement for blood transfusion (18.1 vs 9.0%; OR: 2222; 95% CI: 0.928-5.289) fairly reached the level of significance. There were no early postoperative deaths in the analysed groups.
Patients who walk <500 m during the 6MWT before lobectomy have an increased risk of postoperative complications and prolonged hospital stay.
运动试验是肺癌患者根治性肺切除术前标准肺评估的一项辅助手段。目前缺乏证据支持在术前评估中常规开展这些简单生理检查的重要性。
2009年4月至2011年10月期间，253例在单一机构接受肺叶切除术的肺癌患者纳入本研究。所有患者均依据标准评估方案接受手术切除。此外，在手术前一天，患者进行6分钟步行试验（6MWT）。根据6MWT结果对患者进行分类，以分层其术后并发症风险。基于ROC曲线下的最大面积评估6MWT的阈值。
共148例男性和105例女性，平均年龄63岁。所有患者均因原发性肺癌接受肺叶切除术。500米的距离和预测6MWT的100%被用作区分术后并发症风险的阈值。500米的截断值区分出术后并发症风险增加的个体[60.6%对36.9%，优势比（OR）：2.631；95%置信区间（CI）：1.423 - 4.880]以及住院时间延长（7天对6天）。应用500米的截断值，房颤发生率更高（21.2%对11.7%；OR：2.019；95% CI：0.904 - 4.484）以及输血需求更高（18.1%对9.0%；OR：2.222；95% CI：0.928 - 5.289）均达到显著水平。分析组中无术后早期死亡病例。
肺叶切除术前6MWT期间步行距离<500米的患者术后并发症风险增加且住院时间延长。
