The impact of decreasing cutoff values for maximal oxygen consumption (vo2max) in the decision-making process for candidates to lung cancer surgery

Gaetano Rocco, Tindaro Gatani, Massimo Di Maio, Ilernando Meoli, Antonello La Rocca, Nicola Martucci, Carmine La Manna, Francesco Stefanelli

Research output: Contribution to journalArticle

Abstract

Background: Maximal oxygen consumption (VO2max) is considered a decisive test for risk prediction in patients with borderline cardiopulmonary reserve. Guidelines have adopted decreasing VO2max cut-off values to define operability within acceptable mortality and morbiditylimits. We wanted to investigate how the adoption of decreasing VO2max cut-off-values assessment contributed to better select lung surgerycandidates. Methods: One hundred and nineteen consecutive surgical candidates have been prospectively analyzed as a sample population. Preoperative work-up included spirometry and transfer factor (DLco); irrespective of the spirometric values, these patients were subjected toVO2max assessment. Surgical eligibility was decided by the same surgeon throughout the series. In the postoperative period, overall mortality and the occurrence of any, major or minor complications was recorded and graded according to the Common Terminology Criteria for Adverse Events v.4.3. Results: Three arbitrary cut-offs were introduced at15, 14 and 12 mL.kg-1.min-1. Notably, 15 and 12 mL.kg-1.min-1 correlated with percentage VO2max values of 50% and 35% of predicted (P2max less than 35% (P=0.0017) and CTCAE >2 (P=0.0457) emerged as significant predictors of survival after surgery.Conversely on logistic regression analysis, age over 70 years (P=0.03) and pneumonectomy (P=0.001), but not VO2max cut-off values, were significant predictors of major (CTCAE >2) morbidity. Conclusions: Since VO2max is increasingly used to contribute to risk prediction for the individual patient, surgeons need to be advised that the concept of a definitive, generalized cut-off value for VO2max is probably a contradiction in terms. Patient-specific VO2max values are more likely to contribute to risk assessment since they may reflect the primarilyaffected component among the determinants of maximal oxygen consumption. Whether patient-specific VO2max should be routinely used by surgeons to define operability for borderline patients needs further evaluation.

Original languageEnglish
Pages (from-to)12-18
Number of pages7
JournalJournal of Thoracic Disease
Volume5
Issue number1
DOIs
Publication statusPublished - Feb 2013

Keywords

  • Lung cancer
  • Lung surgery
  • Maximal oxygen consumption

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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