Ventilatory inefficiency adversely affects outcomes and longer-term survival after planned colorectal cancer surgery.

A new interesting article has been published in Br J Anaesth. 2019 Aug;123(2):238-245. doi: 10.1016/j.bja.2019.01.032. Epub 2019 Mar 6. and titled:

Ventilatory inefficiency adversely affects outcomes and longer-term survival after planned colorectal cancer surgery.

Authors of this article are:

Wilson RJT, Yates DRA, Walkington JP, Davies SJ.

A summary of the article is shown below:

BACKGROUND: Impaired cardiorespiratory reserve is an accepted risk factor for patients having major surgery. Ventilatory inefficiency, defined by an elevated ratio of minute ventilation to carbon dioxide excretion (VE/VCO2), and measured by cardiopulmonary exercise testing (CPET), is a pathophysiological characteristic of patients with cardiorespiratory disease. We set out to evaluate the prevalence of ventilatory inefficiency in a colorectal cancer surgical population, and its influence on surgical outcomes and long-term cancer survival.METHODS: In this retrospective study of 1375 patients who had undergone preoperative CPET followed by colorectal cancer surgery, we used receiver operating characteristic curve analysis to identify an optimal value of VE/VCO2 associated with 90-day mortality. Binary logistic regression was used to evaluate whether this degree of ventilatory inefficiency was independently associated with decreased survival, both after surgery and in the longer term.RESULTS: We identified an optimal VE/VCO2 >39 cut-off for predicting 90-day mortality; 245 patients (17.8%) had VE/VCO2 >39, of which 138 (10% of total cohort) had no known cardiorespiratory risk factors. Ventilatory inefficiency was independently associated with death at 90-days (8.2% mortality vs 1.9%; adjusted odds ratio [OR], 4.04; 95% confidence interval [CI], 2.09-7.84), with death after unplanned critical care admission (OR=4.45; 95% CI, 1.37-14.46) and with decreased survival at 2 yr (OR=2.21; 95%, 1.49-3.28) and 5 yr (OR=2.87; 95% CI, 1.54-5.37) after surgery.CONCLUSIONS: A significant proportion of patients having colorectal cancer surgery have ventilatory inefficiency observed on CPET, the majority of whom have no history of cardiorespiratory risk factors. This group of patients has significantly decreased survival both after surgery and in the long-term, irrespective of cancer stage. Survival might be improved by formal medical evaluation and intervention in this group.Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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[link-preview url=https://www.ncbi.nlm.nih.gov/pubmed/30916023 forceshot=true]

This article is a good source of information and a good way to become familiar with topics such as: Aged;Aged, 80 and over;Carbon Dioxide;Colorectal Neoplasms;Exercise Test;Exercise Tolerance;Female;Humans;Lung;Male;Oxygen Consumption;Postoperative Complications;Pulmonary Ventilation;Retrospective Studies;Risk Factors;Survival Analysis;United Kingdom.

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