close attention objective: To evaluate the capability of the stair climbing experiment to predict cardiopulmonary complications after lung resection for lung cancer.

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Design: A prospective cohort of candidates for lung resection. Spirometric assessment and the stair climbing exhibition were performed the day before operation. Univariate and multivariate analyses were performed to identify predictors of postoperative complications.

Setting: Tertiary referral center

Patients: A consecutive series of 160 candidates for lung resection with lung carcinoma from January 2000 by the and of March 2001.

Results: At univariate analysis, the patients with complications were significantly older (p = 002) had a significantly lower FE[Vsub1] percentage (p = 0007) and predicted postoperative FE[Vsub1] percentage (p = 001) had a greater incidence of a concomitant cardiac disease (p = 002) climbed a lower altitude at the stair climbing trial (p < 0.0001), and had a lower calculated maximum oxygen consumption (V[O.sub.2]max) [p = 003] and predicted postoperative [V[O.sub.2]max (p = 0006) compared to the patients without complications. At multivariate analysis, the altitude reached at the stair climbing experiment remained the only significant independent predictor of complications.

Conclusions: The stair climbing standard is a safe and economical exercise example and it was the best predictor of cardiopulmonary complications after lung resection.

fundamental note words: complication; exercise test; lung resection; maximum oxygen consumption; stair climbing test

Abbreviations: DLCO/VA = carbon monoxide diffusion lung capacity corrected for alveolar volume; HR = heart rate; ppoDLCO/VA = predicted postoperative carbon monoxide diffusion lung capacity corrected for alveolar volume; ppoFE[Vsub1] = predicted postoperative FE[Vsub1]; ppoV[O.sub.2]max = predicted postoperative maximum oxygen consumption; V[Osub2] = oxygen consumption; V[O.sub.2]max = maximum oxygen consumption

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Exercise testing is increasingly used in the preoperative evaluation of candidates for lung resection in order to expose severe deficits in systemic oxygen transport. (1) These may be the physiopathologic basis of postoperative cardiopulmonary complications.

The stair climbing ordeal has been traditionally used on thoracic surgeons to select patients before operation. (23) However, not many studies have systematically analyzed this exercise methodology as a preoperative proof (4-7) The aim of the quick in emergencies study was to prospectively assess the part of symptom-limited stair climbing in predicting cardiopulmonary complications after lung resection for non-small confined apartment lung carcinoma.

MATERIALS AND METHODS

single hundred sixty-six candidates for lung resection for non-small confined apartment lung carcinoma from January 2000 in consequence of March 2001 were prospectively chronicleed in the present analysis after giving informed compliance Six patients were excluded from the study: three patients for rigid musculoskeletal disease and three patients for peripheral vascular disease. The remaining 160 patients (128 men and 32 women) formed the database of the analysis. Twenty-eight pneumonectomies, 111 lobectomies, and 21 wedge/segmentectomies were performed between the walls of a muscle-sparing lateral thoracotomy from the same surgical team. Preoperative functional evaluation consisted of spirometry and a symptom-limited stair climbing test

For the plan of the present study, the following spirometric variables were considered: FE[Vsub1]; carbon monoxide diffusion lung capacity corrected for alveolar contortion (DLCO/VA); predicted postoperative FE[V.sub.1] (ppoFE[Vsub1]) calculated through the formula, (preoperative FE[V.sub.1]/No. of preoperative functioning segments) x No. of postoperative functioning segments; predicted postoperative DLCO/VA (ppoDLCO/VA) calculated by dint of the formula, (preoperative DLCO/VA/No. of preoperative functioning segments) x No. of postoperative functioning segments; and FE[Vsub1]/FVC The estimate of the number of functioning sections was done by using quantitative perfusion lung scan. All the spirometric data, with the exception of FE[Vsub1]/FVC were uttered as percentage of predicted for age, sex and height.

The symptom-limited stair climbing touchstone was performed the day before the operation. Our hospital has 16 flights of stairs, each flight having 11 degrees Each step is 0.155 m in height. The patients were asked to climb, at a pace of their possess choice, the maximum number of degrees and to stop only for exhaustion, limiting dyspnea, leg fatigue, or chest pain. The patients were accompanied on a physician during their exercise and encouraged to continue the experiment Moreover, a continuous verbal interaction between the patients and the physician was used in order to assess the patients' dyspnea and the incident of other symptoms. During the exercise, pulsation rate and capillary oxygen saturation were monitored according to means of a portable legumes oximeter. For each patient, the number of gradations climbed and the time taken to unbroken the test were recorded. The following ergometric variables were calculated and used for the analysis: work (height of the gradation in meters x steps by minute x body weight in kilograms x 01635) (4) maximum oxygen consumption (V[O.sub.2]max) in milliliters through minute (5.8 x weight in kilograms + 151 + 101 x work), (4) V[O.sub.2]max corrected for dead body surface area in milliliters by minute squared, and oxygen vibration (V[O.sub.2]max divided by heart rate [HR]) Furthermore, a predicted postoperative V[O.sub.2]max (ppoV[O.sub.2]max) was calculated according to the number of functioning portions removed at operation and estimated according to quantitative lung perfusion scan. (8-10)

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