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Oxygen uptake (VO2) by CPET before lung resection – our experience in one year

Background and Goal of Study: Lung resection, main therapy of lung cancer, has, as a consequence, changed lung function and exercise capacity depending on size of resection and time passed after resection (1). Forced expiratory volume in one second (FEV1) and carbon monoxide lung diffusion capacity (DLCO) are mainstay of patient selection before lung resection (1). Cardiopulmonary exercise test (CPET) is a high- tech test and golden standard of preoperative assessment for thoracic surgery patients at risk (1). The main result of CPET is oxygen uptake (VO2) usually expressed in mL/kg/min (1). No single test of lung function has absolute prognostic value in lung resection (1). Hypothesis: Patients with predicted postoperative VO2 (ppoVO2) values of 10-15 mL/kg/min calculated after preoperative VO2 measured by CPET, can safely undergo major lung resection. Materials and Methods: We retrospectilely collected values of VO2 measured by CPET testing and we callculated (formula as in Brunelli et al.) predicted postoperative values of VO2 (ppoVO2) for patients undergone lung resection in one year and one month on our Clinic for thoracic surgery Jordanovac, Zagreb, Croatia (1). Results are correlated to hospital complications. Results and Discussion: There were 17 lung resection patients needed CPET during preoperative assessment between Sept. 1th 2018. and Oct. 1th 2019. Indications for CPET were low preoperative/predicted postoperative FEV1 and/ or DLCO values and/or anamnesis of poor exercise tolerance and/or planned pulmectomy or bilateral lobectomy or prior lung resection. Preoperative VO2 values were between 5.81 and 33.7 (median 17.4) mL/kg/min and ppoVO2 4.59- 20.5 (median 12.82) mL/kg/min. There was sublobar resection in 2, lobectomy in 11, bilobectomy in 1 and pulmectomy in 3 patients. One patient died after left pulmectomy from cerebrovascular insult. He had preoperative VO2 23.5 mL/kg/min and ppoVO2 12.37 mL/kg/min. Conclusion: Our data shows that it may be possible for patients with low preoperative VO2 and ppoVO2 to safely undergo lung resection to the extent of lobectomy, but we suggest thorough clinical evaluation of comorbidities. References: 1. Brunelli A, Kim AW, Berger KI, Adrizzo- Harris DJ. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest.1013 ; 143(5):166-90.

oxygen uptake ; CPTN ; lung resection

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