Cardiopulmonary exercise testing prior to radical cystectomy: a systematic review and meta‐analysis

Abstract

ObjectiveTo identify the association between cardiopulmonary exercise testing (CPET) and outcomes of radical cystectomy (RC), as RC is historically associated with high rates of short‐ and long‐term morbidity and mortality.MethodsThis quantitative systematic review and meta‐analysis was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta‐Analysis guidelines. An electronic literature search was conducted to identify all relevant studies evaluating the relationship between CPET parameters and RC outcomes. The primary outcome was short‐term mortality. Secondary outcomes included hospital length of stay (LOS) and rate of serious adverse events as defined by the Clavien–Dindo classification.ResultsThe search identified six studies for inclusion. A total of 546 patients underwent CPET prior to RC. There were significantly more deaths following RC observed in patients with poorer cardiopulmonary function (risk ratio RR 5.80, 95% confidence interval 4.96–6.78). There was no significant association between CPET parameters and adverse events or hospital LOS.ConclusionsThe present systematic review and meta‐analysis identified a greater risk of 90‐day mortality in patients with poorer cardiorespiratory function, as measured by CPET. However, there remains a paucity of robust clinical data and further high‐quality studies are required to verify these results.