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Research shows results from a presurgical 6-minute walk test may predict cardiopulmonary risk after uniportal video-assisted thoracic surgery for lung cancer.

A pair of ergometric performance results from a presurgical 6-minute walk test may predict cardiopulmonary complications after uniportal video-assisted thoracic surgery (VATS) for lung cancer, according to a study published in Cancers.

“At present, the functional assessment algorithms used to evaluate fitness for surgical treatment for lung cancer are mostly focused on candidates for open thoracic surgery,” wrote Majed Rafai, MD, of the University Hospital of Marche, and colleagues. “Updated evidence aimed at defining complication predictors in lung cancer patients undergoing curative VATS could refine the risk assessment strategies in current clinical practice.”

Retrospective Analysis

The retrospective, single-center study included 212 consecutive patients with non-small cell lung cancer who underwent uniportal VATS for anatomic lung resection between March 2022 and December 2023. Among them, 23 developed cardiopulmonary complications after surgery.

An analysis of several preoperative patient characteristics, including age, body mass index, forced expiratory volume in 1 second, diffusing capacity for carbon monoxide, American Society of Anesthesiologists score, and cardiac comorbidities, found none were associated with postoperative cardiopulmonary complications.

However, patients with a more complicated postoperative course showed significant differences from those without postoperative cardiopulmonary complications on two measures from the 6-minute walk tests that were part of a preoperative training program: the distance walked at the end of the prehabilitation program and the difference in distance walked between the start and end of the program.

Specifically, achieving less than 458 meters on the 6-minute walk test at the end of the prehabilitation program, and improving by less than 31 meters between the prehabilitation counseling visit and completion of prehabilitation were unique parameters independently linked with postoperative cardiopulmonary complications, according to the study.

Researchers reported that the rate of postoperative cardiopulmonary complications was three to four times higher in patients who performed poorly on the 6-minute walk test.

Adopting the Exercise Test

“We would recommend the systematic adoption of this low-tech exercise test before minimally invasive lung resection in order to complement the risk assessment performance of other risk factors previously identified for open surgery candidates,” the authors wrote. “The results of the [6-minute walk test] could support patients and caregivers for a more informed decision with regard to surgical therapy, as well as the physicians in planning the optimal postoperative pathway of care, especially for subjects at high risk of complications.”