PTU-131 Cardiopulmonary exercise testing predicts prolonged hospital stay following oesophago-gastric cancer surgery

Gut ◽  
2015 ◽  
Vol 64 (Suppl 1) ◽  
pp. A120.2-A120
Author(s):  
B Tan ◽  
K Sylvester ◽  
F Rashid ◽  
V Sujendran ◽  
A Hindmarsh ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Hospital Stay ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Cancer Surgery ◽  
Prolonged Hospital Stay ◽  
Gastric Cancer Surgery ◽  
Cardiopulmonary Exercise ◽  
Prolonged Hospital

scholarly journals P-OGC19 The predictive role of cardiopulmonary exercise testing in gastric cancer surgery

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Jakub Chmelo ◽  
Pooja Prasad ◽  
Joshua Brown ◽  
Maziar Navidi ◽  
Alexander W Phillips
Keyword(s):  
Gastric Cancer ◽  
Hospital Mortality ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Subtotal Gastrectomy ◽  
Cancer Surgery ◽  
Gastric Cancer Surgery ◽  
Cardiopulmonary Exercise ◽  
Predictive Role

Abstract Background The role of Cardiopulmonary Exercise Testing (CPET) prior to major surgery has been an area of growing interest over the last two decades. CPET offers an objective and composite measure of physiological functional reserve, and thus can be used to identify patients at highest risk of peri-operative morbidity and mortality. Although the role of CPET has been investigated with respect to outcomes after oesophagectomy, no clear data exist into the predictive role of CPET specifically relating to gastric cancer surgery. The aim of this study was to identify CPET parameters predictive of adverse outcome in patients undergoing curative gastric resections. Methods Patients who underwent CPET followed by curative total or subtotal gastrectomy for gastric or junctional adenocarcinoma between January 2013 and December 2019 in a single high-volume centre were included in retrospective analysis. CPET variables were categorised as per cut-off values from other surgical populations (AT < 11ml.min-1.kg-1, VO2peak<15ml.min-1.kg-1, VE/VCO2 at AT > 34). Associations between these variables and postoperative outcomes were analysed using chi squared or Fisher’s exact test. Results There were 252 patients included in the study. Patients with VE/VCO2>34 were more likely to return to the intensive care unit (ICU) (p = 0.033) and had a higher chance of in-hospital mortality (p = 0.012). AT < 11ml.min-1.kg-1 or VO2peak<15ml.min-1.kg-1 were not associated either with return to ICU (p = 0.243, p = 0.202) or with in-hospital mortality (p = 1.000, p = 1.000). Conclusions Although much has been published on the importance of CPET assessment prior to major abdominal surgery, there is a paucity of literature specifically looking at its role in patients with gastric cancer. Patients with ventilatory inefficiency (VE/VCO2>34) are more likely to return to ICU or to die during hospital stay after total/subtotal gastrectomy for malignant disease. This information should play a more prominent role when assessing patients’ fitness prior to surgery.

223 - Enhanced Recovery after Esophageal and Gastric Cancer Surgery Reduces Length of Hospital Stay to 7 Days

2018 ◽  
Vol 154 (6) ◽  
pp. S-1261
Author(s):  
Christopher Hadjittofi ◽  
Pedro Serralheiro ◽  
Bhaskar Kumar ◽  
Hugh Warren ◽  
Edward Cheong ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Cancer Surgery ◽  
Gastric Cancer Surgery

scholarly journals Perioperative inflammatory marker as a predictive factor for prolonged postoperative ileus after gastrectomy for gastric cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 31-31
Author(s):  
Hyojin Park ◽  
Yoon Su Kim
Keyword(s):  
Gastric Cancer ◽  
Hospital Stay ◽  
Operative Technique ◽  
Inflammatory Markers ◽  
Postoperative Ileus ◽  
Inflammatory Marker ◽  
Cancer Surgery ◽  
Gastric Cancer Surgery ◽  
Lymphocyte Ratio ◽  
Prolonged Postoperative Ileus

31 Background: Inflammatory markers such as the C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have recently been proposed as prognostic markers for post-operative complications and poor prognosis in solid tumors especially in colon cancer. However, there are few related reports in gastric cancer patients. Therefore, the aim of this study is to assess how perioperative inflammatory markers influence the prolonged postoperative ileus (PPOI) following gastric cancer surgery. Methods: Between 2013 and 2016, 435 patients were diagnosed with gastric cancer and underwent surgery in Gangnam Severance hospital. Patients were divided into prolonged postoperative ileus (PPOI) and control groups. Uncomplicated postoperative ileus (POI) is generally identified as an inevitable process after surgery, which typically resolves within 3 days. Ileus that persists for more than 3 days following surgery is termed PPOI. Results: The total PPOI rate was 33.8%. In univariate analysis, PPOI group was significantly associated with male sex, old age, open operative technique, preoperative gastric outlet obstruction and combined colon resection. PPOI group also was significantly associated with elevated perioperative inflammatory marker (pre- and post-operative CRP, NLR, and PLR). In multivariate analysis, open operative technique and elevated perioperative inflammatory markers (CRP, NLR and PLR) were identified as significant predictors of PPOI. In addition, postoperative length of hospital stay delayed in PPOI group compared with the control group (11.58 ± 9.48 vs.7.98 ± 5.44, respectively; P < 0.001). Conclusions: In this study, PPOI group was significantly associated with elevated perioperative inflammatory marker. Patients with PPOI also are more likely to have an increased postoperative hospital stay. Therefore, the perioperative inflammatory markers may be used as clinically relevant predictive markers for PPOI following gastric cancer surgery

scholarly journals Routine pre- and post-neoadjuvant chemotherapy fitness testing is not indicated for oesophagogastric cancer surgery

2018 ◽  
Vol 100 (7) ◽  
pp. 515-519 ◽  
Author(s):  
RJ Drummond ◽  
D Vass ◽  
H Wadhawan ◽  
CF Craig ◽  
CK MacKay ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Anaerobic Threshold ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Cancer Surgery ◽  
Peak Exercise ◽  
Cardiopulmonary Exercise ◽  
Cardiovascular Morbidity And Mortality ◽  
Cardiopulmonary Complications ◽  
Oesophagogastric Cancer

Introduction There is a known correlation between anaerobic threshold (AT) during cardiopulmonary exercise testing and development of cardiopulmonary complications in high-risk patients undergoing oesophagogastric cancer surgery. This study aimed to assess the value of routine retesting following neoadjuvant chemotherapy. Methods Patients undergoing neoadjuvant chemotherapy with subsequent oesophagogastric cancer surgery with pre- and post-neoadjuvant chemotherapy cardiopulmonary exercise data were identified from a prospectively maintained database. Measured cardiopulmonary exercise variables included AT and maximum oxygen uptake at peak exercise (VO2 peak). Anaerobic threshold values within 1 ml/kg/minute were considered static. Patients were grouped into AT ranges of less than 9 ml/kg/minute, 9–11 ml/kg/minute and greater than 11 ml/kg/minute. Outcome measures were unplanned intensive care stay, postoperative cardiovascular morbidity and mortality. Results Between May 2008 and August 2017, 42 patients from 675 total resections were identified, with a mean age of 65 years (range 49–84 years). Mean pre-neoadjuvant chemotherapy AT was 11.07 ml/kg/minute (standard deviation, SD, 3.24 ml/kg/minute, range 4.6–19.3 ml/kg/minute) while post-neoadjuvant chemotherapy AT was 11.19 ml/kg/minute (SD 3.05 ml/kg/minute, range 5.2–18.1 ml/kg/minute). Mean pre-neoadjuvant chemotherapy VO2 peak was 17.13 ml/kg/minute, while post-chemotherapy this mean fell to 16.59 ml/kg/minute. Some 44.4% of patients with a pre-chemotherapy AT less than 9 ml/kg/minute developed cardiorespiratory complications compared with 42.2% of those whose AT was greater than 9 ml/kg/minute (P = 0.914); 63.6% of patients in the post-neoadjuvant chemotherapy group with an AT less than 9 ml/kg/minute developed cardiorespiratory complications. There was no correlation between direction of change in AT and outcome. Conclusion In our patient population, neoadjuvant chemotherapy does not appear to result in a significant mean reduction in cardiorespiratory fitness. Routine pre- and post-neoadjuvant chemotherapy cardiopulmonary exercise testing is currently not indicated; however, larger studies are required to demonstrate this conclusively.

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