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Cardiopulmonary fitness before and after neoadjuvant chemotherapy in patients with oesophagogastric cancer

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


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© 2018 BJS Society Ltd. Background: Neoadjuvant chemotherapy may have a detrimental impact on cardiorespiratory reserve. Determination of oxygen uptake at the anaerobic threshold by cardiopulmonary exercise testing (CPET) provides an objective measure of cardiorespiratory reserve. Anaerobic threshold can be used to predict perioperative risk. A low anaerobic threshold is associated with increased morbidity after oesophagogastrectomy. The aim of this study was to establish whether neoadjuvant chemotherapy has an adverse effect on fitness, and whether there is recovery of fitness before surgery for oesophageal and gastric adenocarcinoma. Methods: CPET was completed before, immediately after (week 0), and at 2 and 4weeks after neoadjuvant chemotherapy. The ventilatory anaerobic threshold and peak oxygen uptake (Vo2 peak) were used as objective, reproducible measures of cardiorespiratory reserve. Anaerobic threshold and Vo2 peak were compared before and after neoadjuvant chemotherapy, and at the three time intervals. Results: Some 31 patients were recruited. The mean anaerobic threshold was lower following neoadjuvant treatment: 15·3ml per kg per min before chemotherapy versus 11·8, 12·1 and 12·6ml per kg per min at week 0, 2 and 4 respectively (P<0·010). Measurements were also significantly different at each time point (P<0·010). The same pattern was noted for Vo2 peak between values before chemotherapy (21·7ml per kg per min) and at weeks 0, 2 and 4 (17·5, 18·6 and 19·3ml per kg per min respectively) (P<0·010). The reduction in anaerobic threshold and Vo2 peak did not improve during the time between completion of neoadjuvant chemotherapy and surgery. Conclusion: There was a decrease in cardiorespiratory reserve immediately after neoadjuvant chemotherapy that was sustained up to the point of surgery at 4weeks after chemotherapy.

Publication metadata

Author(s): Navidi M, Phillips AW, Griffin SM, Duffield KE, Greystoke A, Sumpter K, Sinclair RCF

Publication type: Article

Publication status: Published

Journal: British Journal of Surgery

Year: 2018

Volume: 105

Issue: 7

Pages: 900-906

Print publication date: 01/06/2018

Online publication date: 30/03/2018

Acceptance date: 02/04/2016

ISSN (print): 0007-1323

ISSN (electronic): 1365-2168

Publisher: John Wiley and Sons Ltd


DOI: 10.1002/bjs.10802


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