Preoperative exercise capacity as a predictor of postoperative pulmonary complications in patients with esophageal cancer: a multicenter observational cohort study
9 affiliations
- 1Department of Rehabilitation Medicine, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558 Japan
- 2Graduate School of Comprehensive Scientific Research, Prefectural University of Hiroshima, Gakuencho 1-1, Mihara, Hiroshima 723-0053 Japan
- 3Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558 Japan
- 4Center for Esophageal Disease, Okayama University Hospital, 2-5-1 Shikatacho, Kita-ku, Okayama, 700-8558 Japan
- 5Department of Rehabilitation Medicine, Akita University Hospital, 44-2 Hasunuma, Hiroomote, Akita, 010-8543 Japan
- 6Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, 288 Matsushima, Kurashiki, Okayama 701-0193 Japan
- 7Department of Esophageal Surgery, Akita University Hospital, 44-2 Hasunuma, Hiroomote, Akita, 010-8543 Japan
- 8Department of Digestive Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192 Japan
- 9Department of Physical Therapy, Faculty of Health and Welfare, Prefectural University of Hiroshima, Gakuencho 1-1, Mihara, Hiroshima 723-0053 Japan
Abstract
Background: Postoperative pulmonary complications (PPCs) after esophageal cancer surgery remain a major concern. Preoperative exercise capacity has emerged as an important predictor. This study examined the clinical use of practical predictors—the 30-s chair stand test (CS-30) and the 6-min walk test (6MWT).
Methods: We retrospectively analyzed patients with esophageal cancer from three institutions who underwent preoperative physical therapy between July 2021 and June 2023. Data completeness for the CS-30 and 6MWT was compared using McNemar’s test. Three logistic regression models predicting PPCs were developed: Model 1 (established risk factors), Model 2 (risk factors plus CS-30), and Model 3 (risk factors plus 6MWT). PPCs were defined as pneumonia or sputum retention requiring intervention (Clavien–Dindo grade ≥ 2). Model performance was evaluated using the area under the curve (AUC), and incremental predictive value was assessed using net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
Results: Among 213 patients (median age 68 years; 83% male), PPCs occurred in 57 (26.8%). Data completeness was significantly higher for the CS-30 (195/213, 91.5%) than the 6MWT (178/213, 83.6%; p < 0.001). The AUCs (95% confidence interval) were 0.775 (0.708–0.842) for Model 1, 0.786 (0.716–0.857) for Model 2, and 0.779 (0.712–0.846) for Model 3. NRI and IDI analyses showed that adding the CS-30 significantly improved reclassification and discrimination abilities.
Conclusions: The CS-30 was more feasible than the 6MWT and significantly improved PPCs prediction. A perioperative management model for high-risk patients based on the CS-30 is recommended.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10388-026-01226-y.
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BibTeX
@article{ikeda2026preoperative,
title = {{Preoperative exercise capacity as a predictor of postoperative pulmonary complications in patients with esophageal cancer: a multicenter observational cohort study}},
author = {Tomohiro Ikeda and Kazuhiro Noma and Kazuki Okura and Hiroki Sato and Sho Katayama and Yusuke Takahashi and Naoaki Maeda and Shunsuke Tanabe and Yusuke Sato and Yoshinori Fujiwara and Masanori Hamada and Toshifumi Ozaki and Tomohiko Nishigami and Toshiyoshi Fujiwara},
journal = {Esophagus},
year = {2026},
month = jun,
doi = {10.1007/s10388-026-01226-y},
url = {https://doi.org/10.1007/s10388-026-01226-y},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Preoperative exercise capacity as a predictor of postoperative pulmonary complications in patients with esophageal cancer: a multicenter observational cohort study
AU - Tomohiro Ikeda
AU - Kazuhiro Noma
AU - Kazuki Okura
AU - Hiroki Sato
AU - Sho Katayama
AU - Yusuke Takahashi
AU - Naoaki Maeda
AU - Shunsuke Tanabe
AU - Yusuke Sato
AU - Yoshinori Fujiwara
AU - Masanori Hamada
AU - Toshifumi Ozaki
AU - Tomohiko Nishigami
AU - Toshiyoshi Fujiwara
PY - 2026
DA - 2026/06/30
JO - Esophagus
DO - 10.1007/s10388-026-01226-y
UR - https://doi.org/10.1007/s10388-026-01226-y
AB - Background: Postoperative pulmonary complications (PPCs) after esophageal cancer surgery remain a major concern. Preoperative exercise capacity has emerged as an important predictor. This study examined the clinical use of practical predictors—the 30-s chair stand test (CS-30) and the 6-min walk test (6MWT). Methods: We retrospectively analyzed patients with esophageal cancer from three institutions who underwent preoperative physical therapy between July 2021 and June 2023. Data completeness for the CS-30 and 6MWT was compared using McNemar’s test. Three logistic regression models predicting PPCs were developed: Model 1 (established risk factors), Model 2 (risk factors plus CS-30), and Model 3 (risk factors plus 6MWT). PPCs were defined as pneumonia or sputum retention requiring intervention (Clavien–Dindo grade ≥ 2). Model performance was evaluated using the area under the curve (AUC), and incremental predictive value was assessed using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results: Among 213 patients (median age 68 years; 83% male), PPCs occurred in 57 (26.8%). Data completeness was significantly higher for the CS-30 (195/213, 91.5%) than the 6MWT (178/213, 83.6%; p < 0.001). The AUCs (95% confidence interval) were 0.775 (0.708–0.842) for Model 1, 0.786 (0.716–0.857) for Model 2, and 0.779 (0.712–0.846) for Model 3. NRI and IDI analyses showed that adding the CS-30 significantly improved reclassification and discrimination abilities. Conclusions: The CS-30 was more feasible than the 6MWT and significantly improved PPCs prediction. A perioperative management model for high-risk patients based on the CS-30 is recommended. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s10388-026-01226-y.
SN - 1612-9059
SN - 1612-9067
ER -