Elderly patient, ? oesophagectomy

75 yo with oesophageal cancer


  • HTN
  • Binge drinker
  • Ex-smoker
  • Epilepsy – absence seizures


  • BP in clinic – 192/70
  • Discussed at CPET group – not taking medications as has no regular GP
  • Spirometry: Mild airflow obstruction, post BD change 28%. Consistent with asthma.
  • CPET – Peak VO2 low at 15.2ml/kg, AT 7.7ml/kg/min. T depression inferolaterally towards peak exercise.
  • Maximal stress test: HRmax – 85% predicted. This patient reached 82% predicted, RER – 1.15. This patient – 1.12. RER (VCO2/VO2)
  • Ventilatory reserve – MVV=FEV1x35, should have at least 20% reserve. Patient has encroached on his ventilatory reserve. HR also raised at this time which could suggest SV limitation. Note patient has not been taking bronchodilators.
  • NAC – surgery planned for 8 weeks post NAC. Concern that patient will significantly decompensate with chemo
  • Borderline – alcohol intake – unwilling to cut-down. Weight loss, non-compliant with medications
  • Social issues – no car, may not be able to participate in prehab, from isolated area
  • Prehab – multiple options. Dr Jen Mackney co-ordinates via CPET MDT and periop clinic. This patient would be better suited to a supervised program. 


  • Restart antihypertensives and bronchodilators
  • Formal stress imaging
  • Prehab and re-test preoperatively before deciding if fit for surgery.