Suri Aditi, Mishra Seema, Bhatnagar Sushma, Garg Rakesh, Jee Bharti Sachidanant, Kumar Vinod, Gupta Nishkarsh, Kumar Sunil, Sharma Atul, Deo Suryanarayana
Department of Onco-Anaesthesia and Palliative Medicine, Dr. BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India.
Department of Surgical Oncology, Dr. BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India.
Turk J Anaesthesiol Reanim. 2022 Oct;50(5):358-365. doi: 10.5152/TJAR.2022.21158.
Neoadjuvant chemotherapy improves resectability rates of oesophageal cancer, but the process may also take a toll on the patients' exercise capacity and may adversely affect the postoperative outcomes. It can be assessed objectively using cardiopulmonary exercise testing.
Patients with oesophagus cancer performed a baseline test and a second test after neoadjuvant chemotherapy during the week preceding oesophagectomy. They were followed up for postoperative complications, length of hospital stay, and 30-day mortality.
Thirty-three patients completed the study. The mean pre-chemotherapy peak oxygen uptake (VO2 peak) was 1128.39 ± 202.79 mL min-1 (19.46 ± 3.06 mL kg-1 min-1 ) which declined to 1010.33 ± 195.56 mL min-1 (17.24 ± 2.55 mL kg-1 min-1 ) in the postchemotherapy period (P < .001). Pre-chemotherapy anaerobic threshold was 906.85 ± 176.81 mL min-1 (15.54 ± 2.24 mL kg-1 min-1 ) which declined to 764.76 ± 158.79 mL min-1 (13.01 ± 2.22 mL kg-1 min-1 ) (P < .001) in the post-chemotherapy period. Six patients developed complications of modified Clavien-Dindo grade 3 and above. Two (6.1%) patients succumbed to complications within 30 days. The mean anaerobic threshold in patients who suffered complications modified Clavien-Dindo grade ≥3 was 693.33 ± 140.99 mL min-1 (11.2 ± 1.17 mL kg-1 min-1 ) while patients with mild to moderate complications had a mean anaerobic threshold 13.41 ± 2.21 mL kg-1 min-1 (P < .006). An optimal cut off value for anaerobic threshold was 12.5 mL kg-1 min-1 Conclusion: Cardiopulmonary exercise testing accurately predicts outcomes in cancer oesophagus patients who undergo neoadjuvant chemotherapy followed by surgery.
新辅助化疗可提高食管癌的可切除率，但这一过程也可能损害患者的运动能力，并可能对术后结果产生不利影响。可通过心肺运动试验进行客观评估。
食管癌患者在食管切除术前行新辅助化疗期间，于基线期及化疗后进行第二次测试。对患者术后并发症、住院时间及30天死亡率进行随访。
33例患者完成研究。化疗前平均峰值摄氧量（VO2峰值）为1128.39±202.79 mL·min-1（19.46±3.06 mL·kg-1·min-1），化疗后降至1010.33±195.56 mL·min-1（17.24±2.55 mL·kg-1·min-1）（P<.001）。化疗前无氧阈值为906.85±176.81 mL·min-1（15.54±2.24 mL·kg-1·min-1），化疗后降至764.76±158.79 mL·min-1（13.01±2.22 mL·kg-1·min-1）（P<.001）。6例患者出现改良Clavien-Dindo 3级及以上并发症。2例（6.1%）患者在30天内死于并发症。Clavien-Dindo分级≥3级并发症患者的平均无氧阈值为693.33±140.99 mL·min-1（11.2±1.17 mL·kg-1·min-1），而轻度至中度并发症患者的平均无氧阈值为13.41±2.21 mL·kg-1·min-1（P<.006）。无氧阈值的最佳截断值为12.5 mL·kg-1·min-1。结论：心肺运动试验能准确预测接受新辅助化疗后手术的食管癌患者的预后。
