Does VO2peak Provide a Prognostic Value in Esophagectomy and Gastrectomy for Post-operative Outcomes?

Abstract

Background/aim: Esophagectomy and gastrectomy are procedures with considerable physical burden and intense post-operative care of which the patient's physical condition seems to be a relevant predictor. The gold standard of the cardiorespiratory fitness is the peak oxygen consumption (VO₂peak). This pilot study examined the prognostic value of VO₂peak on post-surgery outcomes in esophageal and gastric cancer patients.

Patients and methods: In this prospective cross-sectional study, patients scheduled for esophagectomy or gastrectomy were examined 24 h before the surgery regarding their VO₂peak. The post-operative complications according to Clavien-Dindo grade IIIb/IV/V, Intensive-Care-Unit days, and overall hospital stay were documented following surgery. In a subset, body weight changes from surgery until hospital discharge and first aftercare visit were recorded.

Results: The functional capacity was significantly reduced in 34/35 of the included patients compared to matched norm-values (p<0.01). The only significant correlation was found between VO₂peak values and body weight change from surgery to the first aftercare visit. A subgroup comparison of patients with a VO₂peak <17 ml/min/kg and ≥17 ml/min/kg suggested small, non-significant differences in post-surgery outcomes and significant differences in the body weight change from surgery to hospital discharge, favoring the higher-VO₂peak subgroup.

Conclusion: The impaired functional capacity following esophagectomy or gastrectomy may strengthen the rational for exercise programs during neoadjuvant and pre-surgery phases. The prognostic value of VO₂peak on post-operative outcomes remains uncertain due to noticeable descriptive differences, but no significant correlations, potentially limited by the smallsized population. Nonetheless, a correlation between VO₂peak and body weight change post-surgery was observed and indicates a potential prognostic value of VO₂peak.

Keywords: Esophagectomy; VO2peak; cardiopulmonary fitness; post-surgery outcomes; tumor surgery.