CT Bolliger, P Jordan, M Soler, P Stulz, E Gradel, K Skarvan, S Elsasser, M Gonon, C Wyser and M Tamm
Department of Internal Medicine, University Hospital, Basel, Switzerland.

Exercise testing with measurement of maximal oxygen uptake (VO2max) is increasingly used in the assessment of lung resection candidates, but its predictive value for postoperative complications remains controversial. We therefore sought to determine the prognostic value of VO2max compared with other pulmonary function tests. A consecutive group of 80 patients (mean age 61 yr; 57 males and 23 females) scheduled for lung resection (62 malignancies, 12 benign disorders, and 6 carcinoids) underwent pulmonary function tests and symptom-limited cycle ergometry. All patients underwent lung resections: 21 pneumonectomies, 45 lobectomies, and 14 segmental or wedge resections. Group A (64 patients, 80%) had an uneventful postoperative course, whereas Group B (16 patients, 20%) had complications; 3 of them died (4% overall mortality rate). In a stepwise logistic regression analysis used to determine independent risk factors for postoperative complications (within 30 d), VO2max expressed as a percentage of predicted (84 +/- 19 for Group A versus 61 +/- 11 for Group B) proved to be the best predictor (predictive value 85.5%). Although VO2max expressed in absolute values (ml/kg/min) was also highly predictive (79.5%), a ROC curve analysis proved the percentage predicted values to be significantly more sensitive. Of 9 patients with a VO2max < 60% of predicted, 8 had complications, including all 3 patients who died after resections of more than one lobe (sensitivity 50%, specificity 98%). The estimated probability (probit model SAS software package) of suffering no complication was 0.9 for VO2max > 75% of predicted and 0.1 for a VO2max < 43%.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				L. Luzzi, S. Tenconi, L. Voltolini, P. Paladini, C. Ghiribelli, M. Di Bisceglie, and G. Gotti Long-term respiratory functional results after pneumonectomy. Eur. J. Cardiothorac. Surg., July 1, 2008; 34(1): 164 - 168. [Abstract] [Full Text] [PDF]

				W. K. Bernstein and S. Deshpande Preoperative Evaluation for Thoracic Surgery Seminars in Cardiothoracic and Vascular Anesthesia, June 1, 2008; 12(2): 109 - 121. [Abstract] [PDF]

				A. Bobbio, A. Chetta, L. Ampollini, G. L. Primomo, E. Internullo, P. Carbognani, M. Rusca, and D. Olivieri Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer Eur. J. Cardiothorac. Surg., January 1, 2008; 33(1): 95 - 98. [Abstract] [Full Text] [PDF]

				R. P. Benzo, S. Paramesh, S. A. Patel, W. A. Slivka, and F. C. Sciurba Optimal Protocol Selection for Cardiopulmonary Exercise Testing in Severe COPD Chest, November 1, 2007; 132(5): 1500 - 1505. [Abstract] [Full Text] [PDF]

				G. L. Colice, S. Shafazand, J. P. Griffin, R. Keenan, and C. T. Bolliger Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery: ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 161S - 177S. [Abstract] [Full Text] [PDF]

				Y. Ohno, H. Koyama, M. Nogami, D. Takenaka, S. Matsumoto, M. Yoshimura, Y. Kotani, and K. Sugimura Postoperative Lung Function in Lung Cancer Patients: Comparative Analysis of Predictive Capability of MRI, CT, and SPECT Am. J. Roentgenol., August 1, 2007; 189(2): 400 - 408. [Abstract] [Full Text] [PDF]

				G. Gould and A. Pearce Assessment of suitability for lung resection CEACCP, June 1, 2006; 6(3): 97 - 100. [Full Text] [PDF]

				S.-W. Song, H.-S. Lee, M. S. Kim, J. M. Lee, J. H. Kim, B.-H. Nam, and J. I. Zo Preoperative Serum Fibrinogen Level Predicts Postoperative Pulmonary Complications After Lung Cancer Resection Ann. Thorac. Surg., June 1, 2006; 81(6): 1974 - 1981. [Abstract] [Full Text] [PDF]

				A. Bobbio, A. Chetta, P. Carbognani, E. Internullo, A. Verduri, G. Sansebastiano, M. Rusca, and D. Olivieri Changes in pulmonary function test and cardio-pulmonary exercise capacity in COPD patients after lobar pulmonary resection Eur. J. Cardiothorac. Surg., November 1, 2005; 28(5): 754 - 758. [Abstract] [Full Text] [PDF]

				Y. Ohno, H. Hatabu, T. Higashino, M. Nogami, D. Takenaka, H. Watanabe, M. Van Cauteren, M. Yoshimura, M. Satouchi, Y. Nishimura, et al. Oxygen-enhanced MR Imaging: Correlation with Postsurgical Lung Function in Patients with Lung Cancer Radiology, August 1, 2005; 236(2): 704 - 711. [Abstract] [Full Text] [PDF]

				P. Magdeleinat, A. Seguin, M. Alifano, S. Boubia, and J.-F. Regnard Early and long-term results of lung resection for non-small-cell lung cancer in patients with severe ventilatory impairment Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 1099 - 1105. [Abstract] [Full Text] [PDF]

				C.S. Pramesh, R. C. Mistry, and A. Rangole Does the shuttle walk test correlate with postoperative morbidity in lung surgery? Eur. J. Cardiothorac. Surg., June 1, 2005; 27(6): 1133 - 1133. [Full Text] [PDF]

				J. I. Keddissi and G. T. Kinasewitz The More, the Better: Maximum Oxygen Uptake and Lung Resection Chest, April 1, 2005; 127(4): 1092 - 1094. [Full Text] [PDF]

				T. Win, A. Jackson, L. Sharples, A. M. Groves, F. C. Wells, A. J. Ritchie, and C. M. Laroche Cardiopulmonary Exercise Tests and Lung Cancer Surgical Outcome Chest, April 1, 2005; 127(4): 1159 - 1165. [Abstract] [Full Text] [PDF]

				A. Brunelli, A. Sabbatini, F. Xiume', A. Borri, M. Salati, R. D. Marasco, and A. Fianchini Inability to perform maximal stair climbing test before lung resection: a propensity score analysis on early outcome Eur. J. Cardiothorac. Surg., March 1, 2005; 27(3): 367 - 372. [Abstract] [Full Text] [PDF]

				T. Win, A. Jackson, A. M. Groves, F. C. Wells, A. J. Ritchie, H. Munday, and C. M. Laroche Relationship of shuttle walk test and lung cancer surgical outcome Eur. J. Cardiothorac. Surg., December 1, 2004; 26(6): 1216 - 1219. [Abstract] [Full Text] [PDF]

				M L G Janssen-Heijnen, S Smulders, V E P P Lemmens, F W J M Smeenk, H J A A van Geffen, and J W W Coebergh Effect of comorbidity on the treatment and prognosis of elderly patients with non-small cell lung cancer Thorax, July 1, 2004; 59(7): 602 - 607. [Abstract] [Full Text] [PDF]

				S. A. Smulders, F. W. J. M. Smeenk, M. L. G. Janssen-Heijnen, and P. E. Postmus Actual and Predicted Postoperative Changes in Lung Function After Pneumonectomy: A Retrospective Analysis Chest, May 1, 2004; 125(5): 1735 - 1741. [Abstract] [Full Text] [PDF]

				A. Brunelli, M. Monteverde, M. Al Refai, and A. Fianchini Stair climbing test as a predictor of cardiopulmonary complications after pulmonary lobectomy in the elderly Ann. Thorac. Surg., January 1, 2004; 77(1): 266 - 270. [Abstract] [Full Text] [PDF]

				J. R. Burke, I. G. Duarte, V. H. Thourani, and J. I. Miller Jr Preoperative risk assessment for marginal patients requiring pulmonary resection Ann. Thorac. Surg., November 1, 2003; 76(5): 1767 - 1773. [Abstract] [Full Text] [PDF]

				D. Datta and B. Lahiri Preoperative Evaluation of Patients Undergoing Lung Resection Surgery Chest, June 1, 2003; 123(6): 2096 - 2103. [Abstract] [Full Text] [PDF]

				ATS/ACCP Statement on Cardiopulmonary Exercise Testing Am. J. Respir. Crit. Care Med., January 15, 2003; 167(2): 211 - 277. [Full Text] [PDF]

				M. K. Ferguson and A. E. Durkin A comparison of three scoring systems for predicting complications after major lung resection Eur. J. Cardiothorac. Surg., January 1, 2003; 23(1): 35 - 42. [Abstract] [Full Text] [PDF]

				M. A. Beckles, S. G. Spiro, G. L. Colice, and R. M. Rudd The Physiologic Evaluation of Patients With Lung Cancer Being Considered for Resectional Surgery Chest, January 1, 2003; 123(1_suppl): 105S - 114S. [Abstract] [Full Text] [PDF]

				A. Brunelli, M. Al Refai, M. Monteverde, A. Sabbatini, F. Xiume, and A. Fianchini Predictors of early morbidity after major lung resection in patients with and without airflow limitation Ann. Thorac. Surg., October 1, 2002; 74(4): 999 - 1003. [Abstract] [Full Text] [PDF]

				B. Chenuel, P. Haouzi, P. Olivier, P.Y. Marie, B. Chalon, and J. Borrelly Effect of exercise on lung-perfusion scanning in patients with bronchogenic carcinoma Eur. Respir. J., September 1, 2002; 20(3): 710 - 716. [Abstract] [Full Text] [PDF]

				P. Ciriaco, A. Carretta, G. Calori, P. Mazzone, and P. Zannini Lung resection for cancer in patients with coronary arterial disease: analysis of short-term results Eur. J. Cardiothorac. Surg., July 1, 2002; 22(1): 35 - 40. [Abstract] [Full Text] [PDF]

				A. Brunelli, M. Al Refai, M. Monteverde, A. Borri, M. Salati, and A. Fianchini Stair Climbing Test Predicts Cardiopulmonary Complications After Lung Resection* Chest, April 1, 2002; 121(4): 1106 - 1110. [Abstract] [Full Text] [PDF]

				C. Alexiou, D. Beggs, M. L. Rogers, L. Beggs, S. Asopa, and F. D. Salama Pneumonectomy for non-small cell lung cancer: predictors of operative mortality and survival Eur. J. Cardiothorac. Surg., September 1, 2001; 20(3): 476 - 480. [Abstract] [Full Text] [PDF]

				J. Wang, J. Olak, R. E. Ultmann, and M. K. Ferguson Assessment of pulmonary complications after lung resection Ann. Thorac. Surg., May 1, 1999; 67(5): 1444 - 1447. [Abstract] [Full Text] [PDF]

				C. WYSER, P. STULZ, M. SOLER, M. TAMM, J. MULLER-BRAND, J. HABICHT, A. P. PERRUCHOUD, and C. T. BOLLIGER Prospective Evaluation of an Algorithm for the Functional Assessment of Lung Resection Candidates Am. J. Respir. Crit. Care Med., May 1, 1999; 159(5): 1450 - 1456. [Abstract] [Full Text] [PDF]

				A-M Nugent, I C Steele, A M Carragher, K McManus, J A McGuigan, J R P Gibbons, M S Riley, and D P Nicholls Effect of thoracotomy and lung resection on exercise capacity in patients with lung cancer Thorax, April 1, 1999; 54(4): 334 - 338. [Abstract] [Full Text]

				M. Licker, M. de Perrot, L. Hohn, J.-M. Tschopp, J. Robert, J.-G. Frey, A. Schweizer, and A. Spiliopoulos Perioperative mortality and major cardio-pulmonary complications after lung surgery for non-small cell carcinoma Eur. J. Cardiothorac. Surg., March 1, 1999; 15(3): 314 - 319. [Abstract] [Full Text] [PDF]

				J. Wang, J. Olak, and M. K. Ferguson DIFFUSING CAPACITY PREDICTS OPERATIVE MORTALITY BUT NOT LONG-TERM SURVIVAL AFTER RESECTION FOR LUNG CANCER J. Thorac. Cardiovasc. Surg., March 1, 1999; 117(3): 581 - 587. [Abstract] [Full Text] [PDF]

				L. Wetstein and J. R. Mault Physiologic Evaluation of the Lung Resection Candidate Ann. Thorac. Surg., September 1, 1996; 62(3): 923 - 923. [Full Text]