• Steve Benington, Angella Bryan, Owen Milne, and Bilal Alkhaffaf.
• Department of Anaesthesia & Intensive Care, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9WL, UK. Electronic address: steve.benington@mft.nhs.uk.
• Eur J Surg Oncol. 2019 Dec 1; 45 (12): 2451-2456.

IntroductionCPET is a routine investigation prior to cardioesophagectomy. Over a 10-year period 200 patients had CPET before elective cardioesophagectomy. We examine the relationship between CPET and outcomes in these patients.Materials And MethodsComplication data were prospectively collected using the Clavien-Dindo system. Logistic regression analysis was used to determine whether 90-day mortality and morbidity were significantly different between fitter and less fit patients.Results90-day mortality was 5.5%. In univariate analysis the following factors were associated with a significantly increased risk of death at 90 days: anaerobic threshold <11 ml kg-1 min-1 OR (95% CI) = 4.38 (1.23,15.6), p = 0.023; V̇O2 peak <15 ml kg-1 min-1 O2 OR (95% CI) = 5.0 (1.42,15.55), p = 0.012; V̇E/V̇CO2 > 34 OR (95% CI) = 4.07 (1.19,14.0), p = 0.026; diabetes mellitus OR (95% CI) = 5.76 (1.55,21.35) p = 0.009. In multivariate logistic regression analysis both diabetes (OR = 5.76 [1.55,21.4] p = 0.009) and presence of ≥ 1 subthreshold CPET value (OR = 6.72 [1.32,29.8] p = 0.021) were significantly associated with increased risk of death at 90 days. Median (95% CI) survival for patients who had a CPET with 'normal' parameters was 1176 (565, 1787) days, compared with 642 (336, 948) days for patients with ≥ one subthreshold parameter. 15.5% of patients had ECG ischaemia; there were no deaths in this group.ConclusionPresence of at least one sub-threshold CPET value at pre-operative testing is associated with increased risk of 90-day mortality and shorter long term survival. These results allow us to better define risks during shared decision-making with patients.Copyright © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

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