Introduction:

Radical cystectomy (RC), gold standard for localised high risk bladder cancer, carries significant morbidity and mortality rates. Baseline fitness has been linked to perioperative outcomes in major abdominal surgery and cardiopulmonary exercise testing (CPET) has been increasingly adopted for pre-operative risk evaluation and optimisation. This study aims to assess how CPET has affected patient outcomes.

Methods:

Routine pre-operative CPET was introduced for all patients considered for RC and data was collected prospectively. For a control group, retrospective data was collected on patients who underwent RC in the preceding two years (total study timeframe 2018-2020). A direct comparison was performed of the two groups.

Results:

38 patients underwent RC in the study timeframe. Of these, 14 patients had CPET pre-operatively. The mean time from diagnosis to RC was 95 days in patients who didn’t have CPET compared to 110 days for those who did (p=0.32), with comparable rates of neoadjuvant chemotherapy (NAC) (62.5% and 64.29%). Average length of stay was 18.6 days compared to 13.87 (p=0.16), favouring the CPET group. The CPET group also had a lower readmission rate within 30 days (13.33% compared to 21.05%, p=0.35). Overall cause-specific mortality within the study timeframe was 36.84%. Within the CPET group, eight had an anaerobic threshold (AT) of <11mL/kg/min (range 6.3-10.5): of these, 50% had Clavien-Dindo complications of grade 2 or higher and the 90 day mortality rate was 37.5% (cf. 0% in those with AT>11 mL/kg/min in this series).

Conclusion:

CPET is a valuable risk evaluation tool. This study suggested that CPET contributed to a clinically non-significant delay to surgery however was associated with reduced length of stay and readmission rates (noting the possible effect of CPET-related selection bias). We found CPET AT <11mL/kg/min is associated with higher rates of patient morbidity and perioperative mortality.

Funding: N/A