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Eur J Cardiothorac Surg 2004;26:1216-1219
© 2004 Elsevier Science NL
a Thoracic Oncology Unit, Papworth Hospital, Papworth Everard, Cambridge CB3 8RE, UK
b Respiratory Physiology Department, Papworth Hospital, Papworth Everard, Papworth, Cambridge CB3 8RE, UK
c Department of Radiology and Nuclear Medicine, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 2QQ, UK
d Cardiothoracic Surgery Department, Papworth Hospital, Papworth Everard, Papworth, Cambridge CB3 8RE, UK
Received 23 April 2004; received in revised form 20 July 2004; accepted 23 July 2004.
* Corresponding author. Tel.: +44-1480-364-916; fax: +44-1480-364-331. (E-mail: thida.win{at}papworth.nhs.uk).
Objective: Surgery remains the treatment of choice in patients with potentially resectable lung carcinoma. Both the British Thoracic Society and American Chest Physician guidelines for the selection of patients with lung cancer surgery suggest the use of a shuttle walk test to predict outcome in patients with borderline lung function. The guidelines suggest that if the patient is unable to walk 250m during a shuttle walk test, they are high risk for surgery. However, there is no published evidence to support this recommendation. Therefore, we undertook a prospective study to examine the relationship between shuttle walk test and surgical outcome in 139 patients undergoing assessment for possible lung cancer surgery. Methods: The shuttle walk test was performed in 139 potentially resectable patients, recruited over a 2 year period, prior to surgery. One hundred and eleven patients underwent surgery. Outcome of surgery, including duration of hospital stay, complication and mortality rates was recorded. Student's t-test was used to compare the shuttle walk distance in patients with good and poor outcome from surgery. Results: Mean age of patients undergoing surgery was 69 years (42–85). Mean shuttle walk distance was 395m (145–780), with a mean oxygen desaturation of 4% (0–14) during the test. Sixty nine patients had a good surgical outcome and 34 had a poor outcome. The shuttle walk distance was not statistically different in the two outcome groups. Conclusion: Shuttle walk distance should not be used to predict poor surgical outcome in lung cancer patients, contrary to current recommendations. It is therefore advisable to perform a formal cardiopulmonary exercise test if at all possible. The usefulness of a shuttle walk test might be improved. It could be compared to a predicted value, as for a formal cardiopulmonary exercise test.
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