Epworth Healthcare, Melbourne, Victoria, Australia.
Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia.
Dis Colon Rectum. 2018 Mar;61(3):400-409. doi: 10.1097/DCR.0000000000001017.
Gas exchange-derived variables obtained from cardiopulmonary exercise testing allow objective assessment of functional capacity and hence physiological reserve to withstand the stressors of major surgery. Field walk tests provide an alternate means for objective assessment of functional capacity that may be cheaper and have greater acceptability, in particular, in elderly patients.
This systematic review evaluated the predictive value of cardiopulmonary exercise testing and field walk tests in surgical outcomes after colorectal surgery.
A systematic search was undertaken using Medline, PubMed, Embase, CINAHL, and PEDro.
Adult patients who had cardiopulmonary exercise testing and/or field walk test before colorectal surgery were included.
The primary outcomes measured were hospital length of stay and postoperative morbidity and mortality.
A total of 7 studies with a cohort of 1418 patients who underwent colorectal surgery were identified for inclusion in a qualitative analysis. Both pooled oxygen consumption at anaerobic threshold (range, 10.1-11.1 mL·kg·min) and peak oxygen consumption (range, 16.7-18.6 mL·kg·min) were predictive of complications (OR for anaerobic threshold, 0.76; 95% CI, 0.66-0.85, p<0.0001; OR for peak oxygen consumption, 0.76; 95% CI, 0.67-0.85, p<0.0001). Patients had significant increased risk of developing postoperative complications if their anaerobic threshold was below this cut point (p<0.001). However, it was not predictive of anastomotic leak (p = 0.644). Shorter distance (<250 m) walked in incremental shuttle walk test, lower anaerobic threshold, and lower peak oxygen consumption were associated with prolonged hospital length of stay, which was closely related to the development of complications.
Variables derived from cardiopulmonary exercise testing are predictive of postoperative complications and hospital length of stay. Currently, there are insufficient data to support the predictive role of the field walk test in colorectal surgery.
心肺运动测试得出的气体交换变量可客观评估功能能力，从而评估生理储备以应对重大手术的压力。场走测试为功能能力的客观评估提供了另一种方法，它可能更便宜，尤其是在老年患者中更容易被接受。
本系统评价评估心肺运动测试和场走测试在结直肠手术后手术结果中的预测价值。
使用 Medline、PubMed、Embase、CINAHL 和 PEDro 进行了系统搜索。
纳入了接受结直肠手术前进行心肺运动测试和/或场走测试的成年患者。
测量的主要结果是住院时间和术后发病率和死亡率。
共确定了 7 项研究，共有 1418 例接受结直肠手术的患者纳入定性分析。无氧阈时的耗氧量（范围 10.1-11.1mL·kg·min）和峰值耗氧量（范围 16.7-18.6mL·kg·min）均与并发症相关（无氧阈的比值比，0.76；95%CI，0.66-0.85，p<0.0001；峰值耗氧量的比值比，0.76；95%CI，0.67-0.85，p<0.0001）。如果患者的无氧阈值低于该切点，则发生术后并发症的风险显著增加（p<0.001）。然而，它不能预测吻合口漏（p = 0.644）。递增穿梭步行测试中行走距离较短（<250m）、无氧阈值较低和峰值耗氧量较低与住院时间延长相关，这与并发症的发生密切相关。
心肺运动测试得出的变量可预测术后并发症和住院时间。目前，尚无足够的数据支持场走测试在结直肠手术中的预测作用。
