Abstract
Objective
Postoperative loss-of-exercise capacity is one of the main concerns for patients undergoing lung cancer surgery. This study was designed to identify the factors associated with loss-of-exercise capacity after lobectomy, using an easy surrogate measure: the 12-m stair-climbing time (SCt).
Methods
Ninety-eight patients undergoing lobectomy for suspected stage I lung cancer were prospectively enrolled. SCt and pulmonary function test were evaluated preoperatively as baseline and at 6 months postoperatively. At 6 months postoperatively, 20 patients dropped out. Loss-of-exercise capacity was defined as at least a 3.3% decline (lower quartile) in the estimated maximal oxygen uptake (VO2t: 43.06 − 0.4 × SCt). Factors associated with loss-of-exercise capacity were analyzed.
Results
Median (interquartile range) baseline SCt was 31.5 (28.2–36.7) s. Baseline SCt was not significantly associated with complications. At 6 months postoperatively, SCt increased by + 4.4 (+ 3.2, + 6.8) s in patients with loss-of-exercise capacity. Sex, smoking status, lobe, procedure, and forced expiratory volume in 1 s showed no significant association with loss-of-exercise capacity. In the multivariable logistic regression, older age (≥ 73 years) (odds ratio: 5.25, 95% confidence interval: 1.50–18.43, p = 0.010) and lower baseline diffusing capacity of the lung for carbon monoxide (< 75%) (odds ratio: 9.23, 95% confidence interval: 1.94–43.93, p = 0.005) were significantly associated with loss-of-exercise capacity.
Conclusion
Age and the baseline diffusing capacity of the lung for carbon monoxide were identified as significant variables associated with variation of exercise capacity after lung cancer surgery, using pre- and postoperative SCt.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. 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 Physiciansevidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e166S–e190.
Brunelli A, Charloux A, Bolliger CT, Rocco G, Sculier JP, Varela G, et al. ERS/ESTS clinical guidelines on fitness for radical therapy in lung cancer patients (surgery and chemo-radiotherapy). Eur Respir J. 2009;34:17–411.
Cataneo DC, Cataneo AJ. Accuracy of the stair climbing test using maximal oxygen uptake as the goldstandard. J Bras Pneumol. 2007;33:128–33.
Cataneo DC, Kobayasi S, Carvalho LR, Paccanaro RC, Cataneo AJ. Accuracy of six minute walk test, stair test and spirometry using maximal oxygen uptake as gold standard. Acta Cir Bras. 2010;25:194–200.
Ambrozin AR, Cataneo DC, Arruda KA, Cataneo AJM. Time in the stair-climbing test as a predictor of thoracotomy postoperative complications. J Thorac Cardiovasc Surg. 2013;145:1093–7.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.
Hamaguchi Y, Kaido T, Okumura S, Kobayashi A, Hammad A, Tamai Y, et al. Proposal for new diagnostic criteria for low skeletal muscle mass based on computed tomography imaging in Asian adults. Nutrition. 2016;32:1200–5.
Brunelli A, Pompili C, Berardi R, Mazzanti P, Onofri A, Salati M, et al. Performance at preoperative stair-climbing test is associated with prognosis after pulmonary resection in stage I non-small cell lung cancer. Ann Thorac Surg. 2012;93:1796–800.
Brunelli A, Pompili C, Salati M, Refai M, Berardi R, Mazzanti P, et al. Preoperative maximum oxygen consumption is associated with prognosis after pulmonary resection in stage I non-small cell lung cancer. Ann Thorac Surg. 2014;98:238–42.
Ferguson MK, Dignam JJ, Siddique J, Vigneswaran WT, Celauro AD. Diffusing capacity predicts long-term survival after lung resection for cancer. Eur J Cardiothorac Surg. 2012;41:e81–e8686.
Ferguson MK, Watson S, Johnson E, Vigneswaran WT. Predicted postoperative lung function is associated with all-cause long-term mortality after major lung resection for cancer. Eur J Cardiothorac Surg. 2014;45:660–4.
Ozeki N, Kawaguchi K, Fukui T, Fukumoto K, Nakamura S, Hakiri S, et al. The diffusing capacity of the lung for carbon monoxide is associated with the histopathological aggressiveness of lung adenocarcinoma. Eur J Cardiothorac Surg. 2017;52:969–74.
Nakamura R, Inage Y, Tobita R, Yoneyama S, Numata T, Ota K, et al. Sarcopenia in resected NSCLC: effect on postoperative outcomes. J Thorac Oncol. 2018;13:895–903.
Ozeki N, Kawaguchi K, Fukui T, Nakamura S, Hakiri S, Mori S, et al. Psoas muscle mass in patients undergoing lung cancer surgery: a prognostic difference between squamous cell carcinoma and adenocarcinoma. Int J Clin Oncol. 2020;25:876–84.
Arbane G, Tropman D, Jackson D, Garrod R. Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: randomised controlled trial. Lung Cancer. 2011;71:229–34.
Stigt JA, Uil SM, van Riesen SJ, Simons FJ, Denekamp M, Shahin GM, et al. A randomized controlled trial of postthoracotomy pulmonary rehabilitation in patients with resectable lung cancer. J Thorac Oncol. 2013;8:214–21.
Karenovics W, Licker M, Ellenberger C, Christodoulou M, Diaper J, Bhatia C, Robert J, et al. Short-term preoperative exercise therapy does not improve long-term outcome after lung cancer surgery: a randomized controlled study. Eur J Cardiothorac Surg. 2017;52:47–544.
Burtin C, Franssen FME, Vanfleteren LEGW, Groenen MTJ, Wouters EFM, Spruit MA. Lower-limb muscle function is a determinant of exercise tolerance after lung resection surgery in patients with lung cancer. Respirology. 2017;22:1185–9.
Brunelli A, Xiumé F, Refai M, Salati M, Marasco R, Sciarra V. Evaluation of expiratory volume, diffusion capacity, and exercise tolerance following major lung resection: a prospective follow-up analysis. Chest. 2007;131:141–7.
Salati M, Brunelli A, Xiumè F, Monteverde M, Sabbatini A, Tiberi M, et al. Video-assisted thoracic surgery lobectomy does not offer any functional recovery advantage in comparison to the open approach 3 months after the operation: a case matched analysis†. Eur J Cardiothorac Surg. 2017;51:1177–82.
Acknowledgements
The authors would like to thank Dr. Y. Kadomatsu for the supervision during the statistical analyses.
Funding
Nothing to declare.
Author information
Authors and Affiliations
Contributions
Conceptualization: NO; data curation: NO; formal analysis: NO; investigation: SI, SH, SN, KK, YM, TI, MN; methodology: NO, TF, SI, YM; project administration: TFCY; Supervision: TFCY; writing—original draft: NO, TF; writing—review & editing: SH, SN, KK, TFCY.
Corresponding author
Ethics declarations
Conflict of interest
Nothing to declare.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Ozeki, N., Fukui, T., Iwano, S. et al. Factors associated with changes in the 12-m stair-climbing time after lung lobectomy. Gen Thorac Cardiovasc Surg 69, 282–289 (2021). https://doi.org/10.1007/s11748-020-01458-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-020-01458-4