Preoperative Exercise Testing Is a Better Predictor of Postoperative Complications than Pulmonary Function Testing for Patients with Lung Cancer


Objective: The aim of this preliminary study was to evaluate the feasibility of exercise testing (ET) for predicting postoperative complications in patients with impaired pulmonary function. Methods: Thirteen patients were prospectively enrolled. The enrollment criteria were FEV1.0% < 70% and emphysema score > 8 by the Goddard classification or interstitial pneumonia on chest computed tomography. Patients underwent testing for pulmonary function, six-minute walking test (6MWT), and stair-climbing test (SCT). Postoperative cardiopulmonary complications (PCPCs) were recorded. Results: Four patients developed PCPCs. There were no significant differences between the patients with PCPCs (n = 4) and those without PCPCs (n = 9) for background data and PFT. The distances achieved in the 6MWT were 503 ± 72.7 m for patients without PCPCs and 369 ± 50.7 m for patients with PCPCs (p = 0.011). The SCT climbing heights were 20.4 ± 5.3 m for patients without PCPCs and 14.9 ± 4.0 m for patients with PCPCs (P = 0.187). Cut-off points, including a 6MFT distance of less than 400 m, SCT height lower than 15 m, and SCT climbing speed less than 8.5 m/min, were predictive of CPCP. Conclusions: Exercise testing is more feasible for predicting postoperative cardiopulmonary complications than stationary pulmonary function testing.

Share and Cite:

Hata, A. , Sekine, Y. , Koh, E. and Yamaguchi, N. (2015) Preoperative Exercise Testing Is a Better Predictor of Postoperative Complications than Pulmonary Function Testing for Patients with Lung Cancer. Open Journal of Thoracic Surgery, 5, 15-20. doi: 10.4236/ojts.2015.51004.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Colice, G.L., Shafazand, S., Griffin, J.P., Keenan, R. and Bolliger, C.T., American College of Chest Physicians (2007) Physiologic Evaluation of the Patient with Lung Cancer Being Considered for Resectional Surgery: ACCP Evidenced-Based Clinical Practice Guidelines (2nd Edition). Chest, 132, 161S-177S.
[2] Sekine, Y., Iwata, T., Chiyo, M., Yasufuku, K., Motohashi, S., Yoshida, S., et al. (2003) Minimal Alteration of Pulmonary Function after Lobectomy in Lung Cancer Patients with COPD. The Annals of Thoracic Surgery, 76, 356-361.
[3] Fishman, A., Martinez, F., Naunheim, K., Piantadosi, S., Wise, R., Ries, A., et al. (2003) National Emphysema Treatment Trial Research Group. A Randomized Trial Comparing Lung-Volume-Reduction Surgery with Medical Therapy for Severe Emphysema. The New England Journal of Medicine, 348, 2059-2073.
[4] Brunelli, A., Al Refai, M., Monteverde, M., Borri, A., Salati, M. and Fianchini, A. (2002) Stair Climbing Test Predicts Cardiopulmonary Complications after Lung Resection. Chest, 121, 1106-1110.
[5] Olsen, G.N. (1989) The Evolving Role of Exercise Testing Prior to Lung Resection. Chest, 95, 218-225.
[6] Datta, D. and Lahiri, B. (2003) Preoperative Evaluation of Patients Undergoing Lung Resection Surgery. Chest, 123, 2096-2103.
[7] Goddard, P.R., Nicholson, E.M., Laszlo, G. and Watt, I. (1992) Computed Tomography in Pulmonary Emphysema. Clinical Radiology, 33, 379-387.
[8] ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories (2002) ATS Statement: Guidelines for the Six-Minute Walk Test. American Journal of Respiratory and Critical Care Medicine, 166, 111-117.
[9] Olsen, G.N., Bolton, J.W., Weiman, D.S. and Hornung, C.A. (1991) Stair Climbing as an Exercise Test to Predict Perioperative Complications of Lung Resection: Two Years’ Experience. Chest, 99, 587-590.
[10] Bechard, D. and Wetstein, L. (1987) Assessment of Exercise Oxygen Consumption as Preoperative Criterion for Lung Resection. The Annals of Thoracic Surgery, 44, 344-349.
[11] Bolliger, C.T., Jordan, P., Solèr, M., Stulz, P., Gradel, E., Skarvan, K., et al. (1995) Exercise Capacity as a Predictor of Postoperative Complications in Lung Resection Candidates. American Journal of Respiratory and Critical Care Medicine, 151, 1472-1480.
[12] Keagy, B.A., Schorlemmer, C.R., Murray, G.F., Starek, P.J.K. and Wilcox, B.R. (1983) Correlation of Preoperative Pulmonary Function Testing with Clinical Course in Patients after Pneumonectomy. The Annals of Thoracic Surgery, 36, 253-257.
[13] Holden, D.A., Rice, T.W., Stelmach, K. and Meeker, D.P. (1992) Exercising Testing, 6-min Walk, and Stair Climb in the Evaluation of Patients at High Risk for Pulmonary Resection. Chest, 102, 1774-1779.
[14] Barua, A., Handagala, S.D., Socci, L., Barua, B., Malik, M., Johnstone, N. and Martin-Ucar, A.E. (2012) Accuracy of Two Scoring Systems for Risk Stratification in Thoracic Surgery. Interactive CardioVasc Thoracic Surgery, 14, 566-569.
[15] Lim, E., Baldwin, D., Beckles, M., Duffy, J., Entwisle, J., Faivre-Finn, C., et al. (2010) Guidelines on the Radical Management of Patients with Lung Cancer. Thorax, 65, iii1-iii27.
[16] Brunelli, A., Morgan-Hughes, N.J., Refai, M., Slati, M., Sabbatini, A. and Rocco, G. (2007) Risk-Adjusted Morbidity and Mortality Models to Compare the Performance of Two Units after Major Lung Resections. The Journal of Thoracic and Cardiovascular Surgery, 133, 88-96.
[17] Falcoz, P.E., Conti, M., Brouchet, L., Chocron, S., Mercier, M., Etievent, J.P., et al. (2007) The Thoracic Surgery Scoring System (Thoracoscore): Risk Model for In-Hospital Death in 15,183 Patients Requiring Thoracic Surgery. The Journal of Thoracic and Cardiovascular Surgery, 133, 325-332.
[18] Chamogeorgakis, T., Toumpoulis, I., Tomos, P., Ieromonachos, C., Angouras, D., Georgiannakis, E., et al. (2009) External Validation of the Modified Thoracoscore in a New Thoracic Surgery Program: Prediction of In-Hospital Mortality. Interactive CardioVasc Thoracic Surgery, 9, 463-466.
[19] Celli, B.R., Halbert, R.J., Isonaka, S. and Schau, B. (2003) Population Impact of Different Definitions of Airway Obstruction. European Respiratory Journal, 22, 268-273.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.