Document Detail

The impact of decreasing cutoff values for maximal oxygen consumption (VO(2)max) in the decision-making process for candidates to lung cancer surgery.
MedLine Citation:
PMID:  23372945     Owner:  NLM     Status:  PubMed-not-MEDLINE    
BACKGROUND: Maximal oxygen consumption (VO(2)max) is considered a decisive test for risk prediction in patients with borderline cardiopulmonary reserve. Guidelines have adopted decreasing VO(2)max cut-off values to define operability within acceptable mortality and morbidity limits. We wanted to investigate how the adoption of decreasing VO(2)max cut-off-values assessment contributed to better select lung surgery candidates.
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 to VO(2)max 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 at 15, 14 and 12 mL(.)kg(-1) (.)min(-1). Notably, 15 and 12 mL(.)kg(-1) (.)min(-1) correlated with percentage VO(2)max values of 50% and 35% of predicted (P<0.0001 and 0.0079), respectively. Accordingly, the patients were subdivided into groups in which the prevalence of postoperative morbidity was recorded. The groups were homogeneous as to age, BMI, preoperative absolute and percentage FEV1 and DLco. In the Cox proportionate-hazards multivariate analysis, VO(2)max 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 VO(2)max cut-off values, were significant predictors of major (CTCAE >2) morbidity.
CONCLUSIONS: Since VO(2)max 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 VO(2)max is probably a contradiction in terms. Patient-specific VO(2)max values are more likely to contribute to risk assessment since they may reflect the primarily affected component among the determinants of maximal oxygen consumption. Whether patient-specific VO(2)max should be routinely used by surgeons to define operability for borderline patients needs further evaluation.
Gaetano Rocco; Tindaro Gatani; Massimo Di Maio; Ilernando Meoli; Antonello La Rocca; Nicola Martucci; Carmine La Manna; Francesco Stefanelli
Related Documents :
24011815 - A new management for limb graft occlusion after endovascular aneurysm repair adding a v...
24905355 - A prospective pilot study to evaluate wound outcomes and levels of serum c-reactive pro...
24322305 - Factors associated with aggravation of esophageal varices after b-rto for gastric varices.
23897505 - Continuous adductor canal blocks are superior to continuous femoral nerve blocks in pro...
3699405 - Nd:yag laser photocoagulation in colorectal adenoma. evaluation of its safety, usefulne...
12803325 - Edge-to-edge repair for functional mitral regurgitation: an echocardiographic study of ...
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of thoracic disease     Volume:  5     ISSN:  2072-1439     ISO Abbreviation:  J Thorac Dis     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-01     Completed Date:  2013-02-04     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101533916     Medline TA:  J Thorac Dis     Country:  China    
Other Details:
Languages:  eng     Pagination:  12-8     Citation Subset:  -    
Department of Thoracic Surgery and Oncology, Division of Thoracic Surgery and Service of Physiopathology, National Cancer Institute, Naples, Italy; ; Division of Respiratory Physiopathology, Monaldi Hospital, Naples, Italy.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  A comparison of the extended-release and standard-release formulations of tacrolimus in de novo kidn...
Next Document:  Esophageal cancer incidence and mortality in China, 2009.