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Response
- PAUL MURRAY (12 February 2008)
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Pre-operative CPX testing
- Chris M Danbury, S O'Neill, A Kitching (10 January 2008)
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PAUL MURRAY
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We are grateful to Dr. Danbury and colleauges for their interest in our paper. It is apparent that preoperative exercise testing is becoming more widely employed in UK practice. I would draw attention to the recently published study by Forshaw et al. which concluded that CPX was of limited value in predicting morbidity following oesophagectomy; in- hospital mortality was however only 1.3% in this group of patients, which may not be representative of wider practice, and I would be interested to see further data from Dr. Danbury's group. Forshaw MJ et al Is CPX a useful test before oesophagectomy ? Ann Thorac Surg 2008 Jan;85(1):294-9 Conflict of Interest:None declared |
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Chris M Danbury, Consultant Anaesthetist , S O'Neill, A Kitching
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Sir We were interested to read the paper of Murray et al1 which demonstrated the value of a shuttle walk test in predicting outcome after oesophagectomy. It would appear that an inability to walk 350m during a test is of similar predictive value to an anaerobic threshold of less than 11ml/Kg/min obtained from formal cardiopulmonary exercise testing (CPX). CPX testing is however much more than anaerobic threshold measurement2. This technique has powerful diagnostic utility, as well as prognostic value. A well conducted CPX test gives an immense amount of physiological data, and a measurement of actual work done by the patient. The data, when mapped out in a typical Wasserman 9 panel plot3, indicates concurrent pathophysiology, such as cardiac ischaemia, COPD or pulmonary hypertension. Since the incorporation of CPX testing into the oesophageal cancer management programme in our hospital, we have tested 23 consecutive patients with oesophagogastric tumours. One patient did not proceed to surgery after their CPX test. No patient tested on the programme died within 30 days of surgery and none remained on intensive care for more than 7 days post-operatively. Murray et al questioned the use of CPX on cost grounds. We believe that in addition to the prediction of relative peri-operative risk, the value of CPX testing is that it enables better diagnosis of underlying co- morbidities, and therefore more precise per-operative (or non-operative) management. Yours sincerely References: 1. Murray P, Whiting P, Hutchinson SP, Ackroyd R, Stoddard CJ, Billings C. Preoperative shuttle walking testing and outcome after oesophagogastrectomy. Br J Anaesth 2007; 99: 809-11 2.Nagamatsu Y, Shima I, Yamana H, Fujita H, Shirouzu K, Ishitake H. Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus. J Thorac Cardiovasc Surg 2001; 121(6):1064-8 3..Wasserman K, Hansen JE, Sue DY, Stringer WW, Whipp BJ. Principles of exercise testing and interpretation. 4th ed. Lippincott Williams and Wilkins; 2005 Conflict of Interest:None declared |
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