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The impact of neoadjuvant chemotherapy on cardiopulmonary physical fitness in gastro-oesophageal adenocarcinoma

Lookup NU author(s): Dr Rhona Sinclair, Dr Maziar Navidi, Professor Michael Griffin, Dr Kate Sumpter


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INTRODUCTION Operable oesophagogastric adenocarcinoma management in the UK includes three cycles of neoadjuvant chemotherapy (NAC) followed by resection. Determination of oxygen uptake at the anaerobic threshold (AT) with cardiopulmonary exercise testing (CPET) is used to objectively measure cardiorespiratory reserve. Oxygen uptake at AT predicts perioperative risk, with low values associated with increased morbidity. Previous studies indicate NAC may have a detrimental impact on cardiorespiratory reserve.METHODS CPET was completed by 30 patients before and after a standardised NAC protocol. The ventilatory AT was determined using the V-slope method, and the peak oxygen uptake and ventilatory equivalents for carbon dioxide measured. Median AT before and after chemotherapy was compared using a paired Student's t-test.RESULTS Median oxygen uptake at AT pre-and post-NAC was 13.9 +/- 3.1 ml/kg/min and 11.5 +/- 2.0 ml/kg/min, respectively. The mean decrease was 2.4 ml/kg/min (95% confidence interval [CI] 1.3-3.85; p<0.001). Median peak oxygen delivery also decreased by 2.17 ml/kg/min (95% CI 1.02-3.84; p=0.001) after NAC. Ventilatory equivalents were unchanged.CONCLUSIONS This reduction in AT objectively quantifies a decrease in cardiorespiratory reserve after NAC. Patients with lower cardiorespiratory reserve have increased postoperative morbidity and mortality. Preventing this decrease in cardiorespiratory reserve during chemotherapy, or optimising the timing of surgical resection after recovery of AT, may allow perioperative risk-reduction.

Publication metadata

Author(s): Sinclair RCF, Navidi M, Griffin SM, Sumpter K

Publication type: Article

Publication status: Published

Journal: Annals of the Royal College of Surgeons of England

Year: 2016

Volume: 98

Issue: 6

Pages: 396-400

Print publication date: 01/07/2016

Online publication date: 03/05/2016

Acceptance date: 31/12/2015

ISSN (print): 0035-8843

ISSN (electronic): 1478-7083

Publisher: The Royal College of Surgeons of England


DOI: 10.1308/rcsann.2016.0135


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