Abstract
Exercise tests have established themselves as an important part of the preoperative functional evaluation of patients being considered for lung cancer surgery. When assessing the apparently healthy patient, the aim is to identify those with underlying and undetected cardiorespiratory deficit that can increase their surgical risk. This then allows for patients to be appropriately counselled and managed through the surgical pathway. Low technology tests, including the 6 min walk test, shuttle walk test, and stair climbing, have an ongoing role in detecting major problems and we recommend their use as a first line screening test. The cardiopulmonary exercise test (CPET), a high technology test, has assumed an important role as the gold standard in detecting and assessing the extent of deficit in the cardiopulmonary system. It can be used either when guidance thresholds are not met or as a standalone test.
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References
Brunelli A, Charloux A, Bollinger CT, et al. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy). Eur Respir J. 2009;34:17–41.
Lim E, Baldwin D, Beckles M, et al. Guidelines on the radical management of patients with lung cancer. Thorax. 2010;65:iii1–iii27.
Brunelli A, Kim AW, Berger KI, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143:e166S–90S.
Charlous A, Brunelli A, Bollinger CT, et al. European Respiratory Society and European Society of Thoracic Surgeons Joint Task Force on Fitness for Radical Therapy. Lung function evaluation before surgery in lung cancer patients: how are recent advances put into practice? A survey among members of the European Society of Thoracic Surgeons (ESTS) and of the Thoracic Oncology Section of the European Respiratory Society (ERS). Interact Cardiovasc Thorac Surg. 2009;9:925–31.
Brunelli A, Pompili C, Salati M. Low-technology exercise test in the preoperative evaluation of lung resection candidates. Monaldi Arch Chest Dis. 2010;73:72–8.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002;166:111–7.
Bagg LR. The 12-min walking distance; its use in the pre-operative assessment of patients with bronchial carcinoma before lung resection. Respiration. 1984;46:342–5.
Markos J, Mullan BP, Hillman DR, et al. Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis. 1989;139:902–10.
Pierce RJ, Copland JM, Sharpe K, Barter CE. Preoperative risk evaluation for lung cancer resection. Chest. 1992;102:1774–9.
Marjanski T, Wnuk D, Bosakowski D, et al. Patients who do not reach a distance of 500 m during the 6-min walk test have an increased risk of postoperative complications and prolonged hospital stay after lobectomy. Eur J Cardiothorac Surg. 2015;47:213–9.
Singh SJ, Morgan MD, Scott S, Walters D, Hardman AE. Development of a shuttle walking test of disability in patients with chronic airways obstruction. Thorax. 1992;47:1019–24.
Singh SJ, Morgan MD, Hardman AE, Rowe C, Bardsley PA. Comparison of oxygen uptake during a conventional treadmill test and the shuttle walking test in chronic airflow limitation. Eur Respir J. 1994;7:2016–20.
Win T, Jackson A, Groves AM, et al. Relationship of shuttle walk test and lung cancer surgical outcome. Eur J Cardiothorac Surg. 2004;26:1216–9.
Win T, Jackson A, Groves AM, Sharples LD, Charman SC, Laroche CM. Comparison of shuttle walk with measured peak oxygen consumption in patients with operable lung cancer. Thorax. 2006;61:57–60.
Benzo RP, Sciurba FC. Oxygen consumption, shuttle walking test and the evaluation of lung resection. Respiration. 2010;80(1):19–23.
Fennelly J, Potter L, Pompili C, Brunelli A. Performance in the shuttle walk test is associated with cardiopulmonary complications after lung resections. J Thorac Dis. 2017;9(3):789–95.
Olsen GN, Bolton JWR, Weiman DS, et al. Stair climbing as an exercise test to predict the postoperative complications of lung resection: two years experience. Chest. 1991;99:587–90.
Brunelli A, Xiume F, Refai M, Salati M, Di Nunzio L, Pompili C, Sabbatini A. Peak oxygen consumption measured during the stair-climbing test in lung resection candidates. Respiration. 2010;80(3):207–11.
Bollinger CT, Jordan P, Soler M, Stulz P, Gradel E, Skarvan K, Elsasser S, Gonon M, Wyser C, Tamm M. Exercise capacity as a predictor of postoperative complications in lung resection candidates. Am J Respir Crit Care Med. 1995;151:1472–80.
Brutsche MH, Spiliopoulos A, Bollinger CT, Licker M, Frey JG, Tschopp JM. Exercise capacity and extent of resection as predictors of surgical risk in lung cancer. Eur Respir J. 2000;15:828–32.
Loewen GM, Watson D, Kohman L, Herndon JE II, Shennib H, Kernstine K, Olak J, Mador MJ, Harpole D, Sugarbaker D, Green M. Preoperative exercise VO2 measurement for lung resection candidates: results of Cancer and Leukaemia Group B Protocol 9238. J Thorac Oncol. 2007;2:619–25.
Bayram AS, Candan T, Gebitekin C. Preoperative maximal exercise oxygen consumption test predicts postoperative pulmonary morbidity following major lung resection. Respirology. 2007;12:505–10.
Brunelli A, Belardinelli R, Refai M, Salati M, Socci L, Pompili C, Sabbatini A. Peak oxygen consumption during cardiopulmonary exercise test improves risk stratification in candidates to major lung resection. Chest. 2009;135:1260–7.
Licker M, Schnyder JM, Frey JG, Diaper J, Cartier V, Inan C, Robert J, Bridevaux PO, Tschopp JM. Impact of aerobic exercise capacity and procedure-related factors in lung cancer surgery. Eur Respir J. 2011;37:1189–98.
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Gooseman, M., Brunelli, A. (2020). Is Low Tech as Good as High Tech Exercise Testing in Assessing Healthy Candidates for Lung Resection?. In: Ferguson, M. (eds) Difficult Decisions in Thoracic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-47404-1_8
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