Is Cardiopulmonary Exercise Testing Predictive of Surgical Complications in Patients Undergoing Surgery for Ovarian Cancer?

SIMPLE SUMMARY: Treatment of ovarian cancer often involves extensive surgery and is associated with an increased risk of surgical complications. Cardiopulmonary exercise testing (CPET) is a tool used to assess patients’ cardiac and respiratory fitness, and the patient’s ability to withstand the rigor of extensive surgery. Cardiorespiratory fitness is recognised as a predictive tool for surgical complications in many surgical specialities but has not yet been assessed in ovarian cancer patients. The aim of our retrospective study was to evaluate the value of CPET in predicting surgical complications in ovarian cancer surgery. In addition, we assessed the relationship between cardiorespiratory fitness and other outcomes such as hospital stay, readmission and resectability of disease. We found that patients with a raised VE/VCO(2) observed during CPET, experienced more surgical complications. However, we did not find a relationship with other outcomes. Future studies are needed to further delineate the predictive value of CPET in this population. ABSTRACT: Preoperative cardiopulmonary exercise testing (CPET) provides an objective assessment of functional capability. In other intra-abdominal surgical specialties, CPET outcomes are predictive of operative morbidity. However, in ovarian cancer surgery, its predictive value remains unknown. In this study, we evaluated the association between CPET performance and surgical morbidity in ovarian cancer patients. Secondly, we assessed the association between CPET performance and other surgical outcomes (i.e., hospital stay, readmission and residual disease). This was a retrospective cohort study of patients undergoing primary surgery for ovarian cancer between 2020 and 2023. CPET performance included peak oxygen uptake (VO(2) max), ventilatory efficiency (VE/VO(2)) and anaerobic threshold. Outcomes were operative morbidity and included intra- and postoperative complications (Clavien–Dindo), hospital stay, readmission within 30 days and residual disease. A total of 142 patients were included. A lower VO(2) peak and a higher VE/VCO(2) were both associated with the occurrence of postoperative complications, and a poorer anaerobic threshold was associated with more transfusions. VE/VCO(2) remained significantly associated after multivariate analysis (p = 0.035). None of the CPET outcomes were associated with length of stay, readmission or residual disease. In conclusion, VE/VCO(2) was significantly associated with an increased risk of all-cause postoperative complications in ovarian cancer patients undergoing primary surgery.