Exercise capacity in the stair-climbing test predicts outcomes of operable esophageal cancer in minimally invasive era |
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| Affiliation: | 1. Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland;2. Surgery Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland;1. Department of Surgical Oncology, The Institute for Cancer Care, Mercy Medical Center, 227 St. Paul Place, 4th Floor Weinberg, Baltimore, MD, 21202-2001, USA;2. European Interbalkan Medical Center, Asklipiou 10, Pilea, 555 35, Thessaloniki, Greece;3. Athens Medical Center, Distomou 5-7, Athens, 151 25, Greece;1. Department of Urology, The Christie NHS Foundation Trust, Manchester, UK;2. Radboudumc, Nijmegen, the Netherlands;3. University Medical Center Hamburg-Eppendorf, Hamburg, Germany;4. Department of Urology, Ruhr University Bochum, Klinikum, Herford, Germany;5. Urological Clinic Department of Surgical Oncological and Gastroenterological Sciences, University Hospital of Padova, Padova, Italy;6. Department of Urology, St George''s University Hospitals NHS Trust, London, UK;7. NIHR Biomedical Research Centre UCLH and Division of Surgery and Interventional Science UCL, London, United Kingdom;8. Universitair Ziekenhuis Leuven, Leuven, Belgium;9. Division of Pediatric Urology, Department of Urology, Radboudumc Amalia Children''s Hospital, Nijmegen, the Netherlands;1. Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany;2. Institute of Pathology, University Hospital RWTH Aachen, Aachen, Germany;3. Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, Düsseldorf, Germany;4. Department of Surgery, Maastricht University Medical Center (MUMC), Maastricht, Netherlands;5. Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany;1. Oncology Service, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK;2. Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan |
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| Abstract: | IntroductionThe risk of complications after esophagectomy highlights the need for careful preoperative assessment. Aim was to assess whether stair-climbing test (SCT) could predict outcomes of patients with operable esophageal cancer in minimally invasive era.Materials and methodsPatients with esophageal cancer were evaluated for surgical treatment in Central Finland Central Hospital from 2012 to March 2021. Of evaluated 162 patients, 138 were scheduled to eventually undergo surgery. The exercise capacity was evaluated with symptom limited SCT. Patients were divided into four study groups on intent-to-treat basis: surgery and the SCT >14 m (Group 1), surgery and the SCT <11 m (Group 2), non-surgical therapy and the SCT <11 m (Group 3) and non-surgical therapy and the SCT >14 m (Group 4). Results were adjusted for confounders.ResultsMajor complication rate was 10.1% vs 40.0% between Group 1 and 2 (p = 0.006), and 90-day mortality 0% vs 20.0% (p < 0.001). Overall survival rates in Groups 1–4 at 1-year were 92.3% vs 72.2% vs 46.8% vs 81.8%, at 3-year 68.5% vs 52.7% vs 15.6% vs 27.3% and at 5-year 58.7% vs 39.5% vs 0% vs 0%, respectively (p < 0.001). In adjusted analysis when compared to Group 1, other groups had increased 5-year mortality hazard (Group 2 HR 2.88 (95% CI 1.25–6.63), Group 3 HR 15.6 (95% CI 5.57–43.5) and Group 4 HR 5.35 (95% CI 2.08–13.7)).ConclusionExercise capacity measured with SCT in esophageal cancer patients is a strong predictor of complications and survival, and is a potential parameter to be included in any risk or prognostic models. |
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| Keywords: | Esophageal cancer Stair-climbing test Esophagectomy |
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