Preoperative aerobic fitness is a predictor of postoperative outcomes in patients undergoing pancreatoduodenectomy

Background: In various surgical cancer populations, a clear association has been reported between low preoperative aerobic fitness and poor postoperative outcomes. Yet, in pancreatic surgery, postoperative complications are mainly linked to pancreatic texture and duct diameter, and the role of aerobic fitness remains unclear. Methods: Patients referred for pancreatoduodenectomy at the University Medical Center Groningen were screened for low aerobic fitness using a questionnaire and referred for cardiopulmonary exercise testing (CPET) for aerobic fitness assessment accordingly. Based on CPET results, patients were classified as unfit when they had an oxygen uptake (VO<inf>2</inf>) at the ventilatory anaerobic threshold =13 ml/kg/min and/or a VO<inf>2</inf> at peak exercise =18 ml/kg/min. All patients received an advice to be physically active preoperatively and postoperative outcomes were compared to fit patients. Results: Of 175 screened patients, 120 (68.6 %) were considered at risk for low aerobic fitness and underwent preoperative CPET. After excluding patients who participated in a supervised prehabilitation program, 106 CPET reports were used in the analysis. Forty-four (41.5 %) patients were classified as unfit. Postoperatively, unfit patients had a higher rate of gastroparesis grade = B complications (40.9 % versus 22.6 % in fit patients, p = 0.043), and a prolonged length of stay (13 days versus 11 days in fit patients, p = 0.014). Conclusions: Low preoperative aerobic fitness is prevalent in patients undergoing pancreatoduodenectomy and a predictor of impaired postoperative outcomes. Aerobic fitness should therefore be included in the preoperative work-up and optimized accordingly in unfit patients scheduled to undergo pancreatoduodenectomy.