Physiological Biomarkers Assessed by Low-Tech Exercise Tests Predict Complications and Overall Survival in Patients Undergoing Pneumonectomy Due to Lung Cancer

Simple Summary Preoperative results of the 6-min walking test help to identify risk of postoperative complications and increased mortality in patients undergoing lobectomy for lung cancer. The aim of the study was to validate the value of 500 m in 6MWT as an indicator, which differentiates risk of complications in patients undergoing pneumonectomy. 125 patients who underwent pneumonectomy at Thoracic Surgery Department between 2009 and 2018. Additionally, on the day before the surgery, patients performed the 6-min walking test. We analyzed 93 men and 32 women with a median age of 63 years. The cut-off value of 500 m identified patients with increased 90-day mortality, first-year mortality, and overall survival. Patients who covered a distance <= 500 m had an increased risk of atrial fibrillation and cardiac complications. Patients who do not reach the distance of 500 m in 6-min walking test have a high risk of early postoperative death after pneumonectomy. Due to its debilitating character pneumonectomy this is last-resort procedure. Preoperative results of the 6-min walking test (6MWT) help to identify high risk of postoperative complications and increased mortality in patients undergoing lobectomy for lung cancer. The aim of the study was to validate the value of 500 m in 6MWT as an indicator, which differentiates risk of complications in patients undergoing pneumonectomy. 125 patients who underwent pneumonectomy at Thoracic Surgery Department between 2009 and 2018. On the day preceding the surgery, patients underwent 6MWT. The patients were in median age of 63 years. The cut-off value of 500 m identified patients with increased 90-day mortality [17.9% vs. 3.5%, odds ratio (OR) 6.271, 95% confidence interval (CI) 1.528-25.739], first-year mortality (30.7% vs. 11.6%, OR 3.378, 95% CI 1.310-8.709), and overall survival (p = 0.02). Patients who covered a distance <= 500 m had an increased risk of atrial fibrillation (35.9% vs. 16.3%, OR 2.880, 95% CI 1.207-6.870) and cardiac complications (38.4% vs. 19.8%, OR 2.537, 95% CI 1.100-5.849). Patients unable to reach 500 m in 6MWT are in a high risk of postoperative death after pneumonectomy, what may be a result of increased frequency of postoperative cardiac complications. Poor result of 6MWT is a predictor of worse overall survival.

Automated summary

Preoperative results of the 6-min walking test help identify high risk of postoperative complications and increased mortality in patients undergoing lobectomy for lung cancer. The value of 500 m in 6MWT can differentiate risk of complications in patients undergoing pneumonectomy. Patients unable to reach 500 m in 6MWT are at high risk of postoperative death, potentially due to increased frequency of postoperative cardiac complications, indicating poor overall survival.