Ivor-Lewis Oesophagectomy with Ischaemic Heart Disease

garychleung

PIG Meeting: 18th February 2021

69 year old man with Oesophageal cancer

Background

  • Routine preoperative CPET testing revealed ischaemic ECG changes, suspicious of LM disease

Issues

  • Asymptomatic. Noted to have an excellent exercise tolerance on DASI.
  • Exercised to 90% of predicted HR with AT of 15.6ml/kg/min and VE/VCO2 24.6. This represents excellent exercise capacity and would usually indicate patient is fit to proceed to major surgery.
  • Discussed with Dr Collins at the Perioperative Cardiology meeting. Concern re left main coronary artery disease – recommended angiogram
  • Coronary angiogram which revealed mid-eccentric LAD stenosis of 60-70% with normal LVEF
  • No coronary intervention required. Plan to proceed with surgery

Discussion

  • Value of CPET in this instance. Was it a useful test?
  • Discussion centered around the finding of a pathology that didn’t require any intervention.
  • Patient didn’t perform Prehab due to possibility of coronary disease. Was he disadvantaged?
  • Should we be performing CPET in all patients for major surgery or just in those who are clinically borderline candidates?
  • Consensus that there is sufficient evidence for CPET testing perioperatively for major surgery. This patient performed well despite recent completion of NAC and that provides treating team with good prognostic information perioperatively.
  • No delays to surgery and prehabilitation unlikely to improve fitness further as already excellent.

Plan