Cardiopulmonary exercise testing and fitness for liver resection

Here is my highlight for the July edition of HPB which has a new impact factor for 2014 of 2.675 !!!

Cardiopulmonary exercise (CPEX) testing has gained considerable popularity in pre-operative assessment of patients undergoing major surgery in a variety of specialties. The test at its most simple level involves placing a patient on a bicycle and asking them to cycle against resistance up to their maximum limit of exertion while undergoing monitoring. This allows assessment of cardiac ischemia by ECG, anaerobic threshold based on gas exchange and oxygen saturation and other parameters such as maximum power output.

In this issue of HPB, Kasivisvanathan et al. from London, evaluated the usefulness of CPEX testing in patients scheduled to undergo major liver resection. The study included 104 patients considered ‘high risk’ out of 218 scheduled to undergo liver surgery during the study period. 70% of patients studied experienced postoperative complications. Using multivariate analysis, the only variable which was associated with increased postoperative morbidity was VO2 level at an anaerobic threshold of <10.2. This AT figure is similar to some other studies in different specialties and should be viewed with some confidence. This may prove to be a useful value to help counsel patients about their risk of surgery and this in itself is an important point. CPEX does not really tell us whether patients should have surgery or not but what it can do is to help quantify the risk of surgery and help the patient reach a fully informed decision about whether to proceed or not. In terms of complications, it would be interesting to see a more complex analysis of whether CPEX can predict resilience to unpredictable complications such as biliary sepsis or unexpected perioperative haemorrhage. liver4 copy

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