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Preoperative exercise Vo2 measurement for lung resection candidates: results of Cancer and Leukemia Group B Protocol 9238.

Publication ,  Journal Article
Loewen, GM; Watson, D; Kohman, L; Herndon, JE; Shennib, H; Kernstine, K; Olak, J; Mador, MJ; Harpole, D; Sugarbaker, D; Green, M ...
Published in: J Thorac Oncol
July 2007

INTRODUCTION: A stepwise approach to the functional assessment of lung resection candidates is widely accepted, and this approach incorporates the measurement of exercise peak Vo2 when spirometry and radionuclear studies suggest medical inoperability. A new functional operability (FO) algorithm incorporates peak exercise Vo2 earlier in the preoperative assessment to determine which patients require preoperative radionuclear studies. This algorithm has not been studied in a multicenter study. METHODS: The CALGB (Cancer and Leukemia Group B) performed a prospective multi-institutional study to investigate the use of primary exercise Vo2 measurement for the prediction of surgical risk. Patients with known or suspected resectable non-small cell lung cancer (NSCLC) were eligible. Exercise testing including measurement of peak oxygen uptake (Vo2), spirometry, and single breath diffusion capacity (DLCO) was performed on each patient. Nuclear perfusion scans were obtained on selected high-risk patients. After surgery, morbidity and mortality data were collected and correlated with preoperative data. Mortality and morbidity were retrospectively compared by algorithm-based risk groups. RESULTS: Three hundred forty-six patients with suspected lung cancer from nine institutions underwent thoracotomy with or without resection; 57 study patients did not undergo thoracotomy. Patients who underwent surgery had a median survival time of 30.9 months, whereas patients who did not undergo surgery had a median survival time of 15.6 months. Among the 346 patients who underwent thoracotomy, 15 patients died postoperatively (4%), and 138 patients (39%) exhibited at least one cardiorespiratory complication postoperatively. We found that patients who had a peak exercise Vo2 of <65% of predicted (or a peak Vo2/kg <16 ml/min/kg) were more likely to suffer complications (p = 0.0001) and were also more likely to have a poor outcome (respiratory failure or death) if the peak Vo2 was <15 ml/min/kg (p = 0.0356). We also found a subset of 58 patients who did not meet FO algorithm criteria for operability, but who still tolerated lung resection with a 2% mortality rate. CONCLUSIONS: Our data provide multicenter validation for the use of exercise Vo2 for preoperative assessment of lung cancer patients, and we encourage an aggressive approach when evaluating these patients for surgery.

Duke Scholars

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Published In

J Thorac Oncol

DOI

EISSN

1556-1380

Publication Date

July 2007

Volume

2

Issue

7

Start / End Page

619 / 625

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Spirometry
  • Prospective Studies
  • Preoperative Care
  • Pneumonectomy
  • Oxygen Consumption
  • Oncology & Carcinogenesis
  • Morbidity
  • Middle Aged
 

Citation

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Loewen, G. M., Watson, D., Kohman, L., Herndon, J. E., Shennib, H., Kernstine, K., … Cancer and Leukemia Group B, . (2007). Preoperative exercise Vo2 measurement for lung resection candidates: results of Cancer and Leukemia Group B Protocol 9238. J Thorac Oncol, 2(7), 619–625. https://doi.org/10.1097/JTO.0b013e318074bba7
Loewen, Gregory M., Dorothy Watson, Leslie Kohman, James E. Herndon, Hani Shennib, Kemp Kernstine, Jemi Olak, et al. “Preoperative exercise Vo2 measurement for lung resection candidates: results of Cancer and Leukemia Group B Protocol 9238.J Thorac Oncol 2, no. 7 (July 2007): 619–25. https://doi.org/10.1097/JTO.0b013e318074bba7.
Loewen GM, Watson D, Kohman L, Herndon JE, Shennib H, Kernstine K, et al. Preoperative exercise Vo2 measurement for lung resection candidates: results of Cancer and Leukemia Group B Protocol 9238. J Thorac Oncol. 2007 Jul;2(7):619–25.
Loewen, Gregory M., et al. “Preoperative exercise Vo2 measurement for lung resection candidates: results of Cancer and Leukemia Group B Protocol 9238.J Thorac Oncol, vol. 2, no. 7, July 2007, pp. 619–25. Pubmed, doi:10.1097/JTO.0b013e318074bba7.
Loewen GM, Watson D, Kohman L, Herndon JE, Shennib H, Kernstine K, Olak J, Mador MJ, Harpole D, Sugarbaker D, Green M, Cancer and Leukemia Group B. Preoperative exercise Vo2 measurement for lung resection candidates: results of Cancer and Leukemia Group B Protocol 9238. J Thorac Oncol. 2007 Jul;2(7):619–625.
Journal cover image

Published In

J Thorac Oncol

DOI

EISSN

1556-1380

Publication Date

July 2007

Volume

2

Issue

7

Start / End Page

619 / 625

Location

United States

Related Subject Headings

  • United States
  • Treatment Outcome
  • Spirometry
  • Prospective Studies
  • Preoperative Care
  • Pneumonectomy
  • Oxygen Consumption
  • Oncology & Carcinogenesis
  • Morbidity
  • Middle Aged