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Clinical relevance of decreased oxygen saturation during 6-min walk test in preoperative physiologic assessment for lung cancer surgery

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Abstract

Objective

The Japanese Association for Chest Surgery (JACS) has released guidelines on preoperative physiologic assessment for lung cancer surgery. However, cardiopulmonary exercise testing (CPET), which is recommended for patients with poor pulmonary function, is available only in limited institutions. We investigated the possibility of 6-min walk test (6MWT) as a substitute of maximum oxygen consumption test (VO2max) on preoperative physiologic assessment for lung cancer surgery.

Methods

The relationship between VO2max and 6MWT was retrospectively analyzed in 51 subjects other than lung cancer patients. Following the preliminary analysis, we modified the risk assessment in the JACS guidelines by substituting 6MWT for VO2max, and patients who underwent lung cancer surgery were retrospectively assessed using the modified assessment.

Results

Analysis of the correlation between VO2max and 6MWT revealed VO2max to be significantly correlated to minimum SpO2 (SpO2min) and maximum decrease in SpO2 (ΔSpO2) during 6MWT. Receiver operating characteristic analysis revealed that SpO2min and ΔSpO2 were predictable for a VO2max of 15 mL/kg/min, which is the borderline between the average- and increased-risk groups in the JACS guidelines. A total of 1,066 patients were assigned to the average- or increased-risk group according to the modified JACS guidelines using the criteria of SpO2min < 91 % and ΔSpO2 > 4 %. The increased-risk group was significantly inferior to the average-risk group in Home Oxygen Therapy induction rate, cardiopulmonary-related 30- and 90-day mortality (p < 0.001).

Conclusions

In clinical practice, decreased saturation during 6MWT may be simple and substitutive for CPET in risk assessment for lung cancer surgery using the JACS guidelines.

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Abbreviations

6MWT:

6-min walk test

JACS:

The Japanese Association for Chest Surgery

CPET:

Cardiopulmonary exercise test

DLCO :

Carbon monoxide diffusion capacity of the lung

FEV1 :

Forced expiratory volume in 1 s

PPO:

Percent predicted postoperative

SpO2 :

Oxygen saturation

VO2max:

Maximum oxygen consumption

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Conflict of interest

The authors have declared that no conflict of interest exists.

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Authors and Affiliations

  1. Department of Thoracic Surgery, Tenri Hospital, 200 Mishima, Tenri, Nara, 632-8552, Japan

    Tatsuo Nakagawa, Naohisa Chiba, Masao Saito, Yasuto Sakaguchi & Shinya Ishikawa

Authors
  1. Tatsuo Nakagawa
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  2. Naohisa Chiba
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  3. Masao Saito
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  4. Yasuto Sakaguchi
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  5. Shinya Ishikawa
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Correspondence to Tatsuo Nakagawa.

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Nakagawa, T., Chiba, N., Saito, M. et al. Clinical relevance of decreased oxygen saturation during 6-min walk test in preoperative physiologic assessment for lung cancer surgery. Gen Thorac Cardiovasc Surg 62, 620–626 (2014). https://doi.org/10.1007/s11748-014-0413-y

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  • DOI: https://doi.org/10.1007/s11748-014-0413-y

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