Objectives: The purpose of the present study was to verify if performance in the 6-min walking test (6MWT) during the preoperative evaluation phase is associated with the development of cardiopulmonary postoperative complications in patients who underwent uniportal VATS (U-VATS) for lung cancer. Methods: This retrospective, monocentric study included patients submitted to U-VATS anatomical lung resections (March 2022–December 2023). The patients were enrolled in a preoperative rehabilitation program carried out 15 days before surgery. The 6MWT was performed at counseling (T0) and after pre-habilitation (T1). Univariate analysis followed by logistic regression verified the association of baseline patients’ characteristics and performance in the 6MWT (meters walked during T0 and T1 and the difference between T1 and T0—T1-T0 variation) with postoperative cardiopulmonary complications (CPCs). Youde’s index was used to establish the optimal cut-offs for ergometric parameters significantly correlated with CPCs. Results: We enrolled 212 patients scheduled to undergo U-VATS lung resection (lobectomies: 177; bilobectomies: 2; segmentectomies: 33). Twenty-three (10.8%) patients developed CPCs. None of the baseline patients’ characteristics were associated with CPCs. Complicated patients showed more significant differences compared to non-complicated ones for meters walked during the 6MWT T1 (6MWT-T1-complicated: 450 vs. 6MWT-T1-non-complicated: 517;p: 0.01) and for variation-T1-T0 (variation-T1-T0-complicated: 4 m vs. variation-T1-T0-non-complicated: 20 m;p: 0.02). The best cut-offs for discriminating between patients with CPCs and those with uneventful courses were 458 m for 6MWT-T1 and 31 m for variation-T1-T0. After multivariate analysis, 6MWT-T1 < 458 m and variation-T1-T0 < 31 m were the unique parameters independently correlated with CPCs (p: 0.03 andp: 0.05, respectively). Conclusions: The 6MWT results (in particular, 6MWT-T1 < 458 m and variation-T1-T0 < 31 m) in the context of a pre-habilitation program are associated with the development of CPCs after U-VATS lung resection.
目的：本研究旨在验证术前评估阶段进行的6分钟步行试验（6MWT）表现是否与接受单孔胸腔镜肺癌手术患者术后心肺并发症的发生相关。方法：这项回顾性单中心研究纳入2022年3月至2023年12月期间接受单孔胸腔镜解剖性肺切除术的患者。所有患者均在术前15天参与预康复计划。6MWT分别在术前咨询时（T0）和预康复完成后（T1）进行。通过单因素分析及逻辑回归模型，检验患者基线特征、6MWT表现（T0与T1阶段步行距离及T1-T0差值）与术后心肺并发症的相关性。采用尤登指数确定与心肺并发症显著相关的运动参数最佳截断值。结果：共纳入212例计划接受单孔胸腔镜肺切除术患者（肺叶切除177例，双肺叶切除2例，肺段切除33例）。23例（10.8%）患者发生心肺并发症。基线特征与并发症无显著关联。并发症组在6MWT-T1步行距离（并发症组：450米 vs 无并发症组：517米；p=0.01）及T1-T0差值（并发症组：4米 vs 无并发症组：20米；p=0.02）方面较无并发症组存在显著差异。区分并发症患者与无并发症患者的最佳截断值为：6MWT-T1距离458米，T1-T0差值31米。多因素分析显示，6MWT-T1<458米及T1-T0差值<31米是唯一与心肺并发症独立相关的参数（p值分别为0.03和0.05）。结论：在预康复计划背景下，6MWT结果（特别是6MWT-T1<458米及T1-T0差值<31米）与单孔胸腔镜肺切除术后心肺并发症的发生具有显著关联。
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