Prediction of morbidity and mortality after thoracoabdominal esophageal surgery

Prediction of morbidity and mortality after thoracoabdominal esophageal surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prediction of morbidity and mortality after thoracoabdominal esophageal surgery Erik Nilsson, Monika Fagevik Olsén, Petrus Boström, Ulrika Trolle, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3866057/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Complications after esophagectomy result in higher morbidity and mortality, longer hospital stays and lower quality of life. Unfortunately, we have insufficient knowledge of which patients will tolerate the combination of strenuous oncological therapy and major surgery. This study was designed to evaluate whether additional physical tests, apart from standard preoperative workups, could help identify high-risk patients regarding esophageal cancer surgery. Methods A total of 88 patients due to undergo esophagectomy for esophageal cancer were enrolled. In addition to the mandatory physical examinations, seven additional physical therapy tests were carried out within 10 days prior to surgery. CT scans were examined by an experienced radiologist to determine whether patients suffered from sarcopenia. Perioperative data and times of death were gathered from a national register. The primary outcome was the presence of any severe postoperative complication, classified as Clavien-Dindo ≥3, with specific complications as secondary outcomes, and associations between preoperative test performance and complications were examined. Results Patients with severe complications had preoperatively performed significantly worse on peak expiratory flow tests (p = 0.013). Patients suffering from anastomotic leakage had shown significantly worse performance on cardiopulmonary exercise testing, whereas the results from shoulder abduction tests were significantly lower in patients who later suffered from pneumonia (p = 0.034 and p = 0.043, respectively). Conclusion More extensive preoperative physical examination tests could potentially aid in identifying patients with an increased risk of postoperative complications. Further studies are needed on the subject to corroborate these findings and evaluate their clinical use. oesophagectomy complication peak expiratory flow shoulder abduction INTRODUCTION In Sweden, patients undergoing surgery for esophageal cancer usually receive perioperative chemotherapy or neoadjuvant radiochemotherapy( 1 ). This extensive oncological treatment and major surgery is associated with high morbidity, especially in elderly patients and those with significant comorbidities and poor physical status ( 2 ). In addition, dysphagia and cancer cachexia often result in considerable weight loss at the time of diagnosis, adding to the risk of complications ( 3 , 4 ). Even for patients with resectable tumors, only 34% undergo treatment with curative intent, illustrating the emphasis on patient selection( 5 ). In Sweden, we regularly use spirometry and submaximal exercise testing to complement the clinician’s physical examination. Several risk factors regarding postoperative complications after esophagectomy have been established, including age, BMI, and chronic obstructive pulmonary disease and sarcopenia, the latter also associated with decreased survival after surgery( 6 – 11 ). However, improved physical tests could potentially help determine the individual’s overall operability and hence determine treatment recommendations. Several tests have shown the potential to determine the patient’s cardiovascular health, general fitness and pulmonary capabilities( 12 – 14 ). Studies have also shown promising effects of preoperative prehabilitation( 15 ). Higher preoperative physical activity levels seem to decrease pulmonary complications( 16 ), and prehabilitation, focusing on inspiratory muscle training and exercise, has been shown to reduce postoperative complications and decrease the length of the hospital stay( 17 ). The aim of this study was to evaluate whether reliable and valid tests of physical strength and stamina could be used as predictors of morbidity and mortality after thoracoabdominal esophageal cancer surgery. METHODS Patients who were due to undergo thoracic abdominal esophagectomy between September 2014 and February 2017 at Sahlgrenska University Hospital, Lund University Hospital or Karolinska University Hospital were asked for their written consent to be enrolled in the study, after receiving appropriate verbal and written information. Inclusion criteria were a planned esophagectomy for cancer and an age of over 18 years. Prior to surgery, the patients met a physiotherapist to perform eight clinically relevant and standardized physical tests, carried out not more than 10 days prior to surgery, with the aim of assessing their cardiopulmonary status and stamina. Patients also completed the mandatory submaximal cardiopulmonary exercise test (CPET)( 18 ) and spirometry, where Peak Expiratory Flow (PEF)( 19 ) and Forced Expiratory Volume (FEV1)( 20 ) was measured. CT images produced prior to treatment decision were gathered and the total psoas area (TPA)( 21 ) was calculated at level L4 by an experienced radiologist. The TPA was then used to calculate the total psoas index (TPI = TPA/height 2 , cm 2 /m 2 ), which in turn was compared between groups and, in further analysis, divided into quartiles. Sarcopenia was defined as TPI in the lowest sex-specific quartile( 22 ). The primary outcome of this study was the presence of any severe complication after surgery, defined as Clavien-Dindo (CD) ≥ 3. The performance in the physical tests, and the presence of sarcopenia, were used as exposure variables, and the associations between the preoperative test results and postoperative complications evaluated. The same analyses were then performed using specific postoperative complications as secondary outcomes: i) anastomotic leakage, ii) bacterial pneumonia, iii) cardiovascular complications, and iv) sepsis. Physical tests The following seven physical tests used in the study are methods of examining cardiopulmonary fitness, muscle stamina and general fitness: The six-minute walk distance test (6MWD) measured the total length a patient was able to walk (meters) in six minutes on a 30-meter-long course( 13 ). Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured with a MicroRPM ™ (Respiratory Pressure Meter: Care Fusion, Sollentuna, Sweden) according to international guidelines. Three attempts were made, and the patient was instructed to exhale and inhale with maximum strength after a maximal inspiration and expiration, respectively ( 23 ). Isometric grip strength of the dominant hand was measured using a hand dynamometer ( Jamar dynamometer, Patterson Medical ®), while the patient was sitting upright in a chair with his/her arm resting on the armrest( 24 ). We carried out three tests, and the highest value was recorded. The shoulder abduction test was conducted with the patient standing. They were instructed to abduct their shoulders to 90º and hold them as long as possible with weights in his/her hands (2 x 2 kg for women, 2 x 3 kg for men). We allowed a single correction of technique if the arms were seen to be dropping, and the duration of abduction was recorded( 25 ). The timed up and go (TUG) test started with the patient seated in a chair. When the timer started, they were instructed to rise from the chair, walk three meters, turn and then return to the chair and sit down, and the time required for the full motion was recorded( 26 ). A timed-stands test measured the total time it took the patient to stand up and sit down 10 times from a standardized chair with a height of 46 cm, without any support from the arms( 27 ). The heel-raise test measured the amount of time necessary for the patient to perform 10 maximal heel raises as quickly as possible, allowing the arms to be used for support. This test had been modified from the original( 28 ). In addition, patients filled out the International Physical Activity Questionnaire (IPAQ) short form( 29 ), a questionnaire regarding self-assessed physical activity level. It includes questions about time spent being physically active at vigorous and moderate levels, and time spent walking during the last seven days. It also includes a question concerning time spent sitting during the same period. In the study, a total weekly MET level was calculated, according to guidelines, by multiplying the reported minutes per week in each category by 3.3 for low-intensity activity, 4.0 for moderate-intensity activity, and 8.0 for vigorous-intensity activity( 30 ). The scores from these three categories were consolidated into a total MET-minutes-per-week score, which was categorized into three levels of physical activity, graded ‘low’, ‘moderate’, and ‘high’. Results from the physical tests and the IPAQ results were gathered on site by the responsible physiotherapist. Epidemiological data Pre-, peri- and postoperative data were gathered from patient case-records and National Register of Esophagus and Ventricle cancer (NREV), a register with reliable and comparable data( 31 ). The register contributed with the following variables: weight, height, smoking habits, American Society of Anesthesiologists (ASA) score, Zubrod score (WHO score), preoperative chemo- or chemoradiation therapy, perioperative bleeding, length of surgery, localization of the tumor, technique for creating the anastomosis, level of the anastomosis, days in hospital, surgical complications, general complications, Clavien-Dindo classification of the most severe complication, histological type, and tumor-free margins. Statistical analysis Continuous variables were first analyzed to determine whether the data was normally distributed. Normally distributed variables were then evaluated using the student’s t-test, and non-normal variables using the Mann-Whitney U test. The chi-squared test or Fisher’s exact test were used for comparing categorical variables. Univariable logistic regression analyses were used to examine the association between exposures and outcomes, and the study was designed to perform a multiple logistic regression using only significant results from the univariable analyses. A two-tailed p-value < 0.05 was considered significant. All statistical analyses were performed using SPSS (IBM SPSS Statistics for Macintosh, Version 25.0). Results A total of 114 patients were enrolled in the study. Seven patients were excluded due to metastatic disease, 11 patients due to no esophagectomy being performed, and eight patients for whom no data were found in the register. Altogether, 88 patients were included in the analyses. In this cohort, 24 patients had severe postoperative complications. Thirty–day mortality was zero, but two patients died within 90 postoperative days. Demographic and complication data are presented in Table 1 . The mean age of patients included in the study was 66 years, a majority was male (81%), with a mean body mass index of 26.2 kg/m2, with no significant differences between the two groups. Most patients were diagnosed with adenocarcinoma (80%). Eight patients who were eligible for surgery had an ASA score 3, with the rest either ASA 1 (51%) or ASA 2 (40%). 52% received neoadjuvant radio chemotherapy and 77% perioperative chemotherapy. Patients with severe complications had a longer hospital stay (24 vs 12 days, p-value < 0.005). Overall, the most common complication was anastomotic leakage, followed by bacterial pneumonia, cardiovascular complications, and sepsis. Table 1 Characteristics of the 88 patients undergoing esophageal surgery All (n = 88) Clavien-Dindo ≥3 (n = 24) Clavien- Dindo < 3 (n = 64) P-value Sex (male) 71 (81) 16 (68) 55 (86) 0.66 Age (y) 66 (60–71) 66 (61–72) 67 (60–71) 0.893 BMI 26.2 (23.8–28.8) 26.5 (24.4–29.4) 25.9 (23.1–28.4) 0.114 Histology Adenocarcinoma 70 (80) 22 (92) 48 (75) 0.136 Squamous cell carcinoma 15 (17) 2 (8) 13 (20) 0.222 Others 3 (3) 0 3 (5) 0.559 ASA 1 44 (51) 15 (65) 29 (45) 0.231 2 35 (40) 4 (18) 31 (48) 0.007 3 8 (9) 4 (17) 4 (6) 0.206 Total psoas index (cm 2 /m 2 ) 8.2 (6.6–9.7) 7.8 (6.3–10.7) 8.4 (6.7–9.6) 0.634 Sarcopenia prior to surgery 20 (22) 5 (21) 15 (23) 0.606 Neoadjuvant chemotherapy 68 (77) 19 (79) 49 (77) 1 Neoadjuvant radiochemotherapy 46 (52) 15 (63) 31 (48) 0.338 Perioperative bleeding (ml) 300 (200–575) 300 (75–600) 300 (200–500) 0.384 Time surgery (min) 469 (405–570) 443 (353–550) 474 (413–570) 0.843 Level of anastomosis Inferior pulmonary vein 4 (5) 2 (8) 2 (3) 0.571 Vena azygos 57 (65) 17 (71) 40 (64) 0.617 Apex of the chest 20 (23) 3 (13) 17 (27) 0.253 Neck 6 (7) 2 (8) 4 (6) 1 Days in hospital (n) 20 (10–21) 33 (14–45) 15 (9–16) < 0.005 90-day mortality 2.3% 1 (4) 1 (2) 1 Complications post surgery General complication 29 12 17 0.075 Surgical complication 23 18 5 < 0.005 Anastomotic leakage 12 11 1 < 0.001 Bacterial pneumonia 9 4 5 0.248 Cardiovascular complications 8 3 5 0.678 Sepsis 7 4 3 0.085 n. recurrens damage 5 2 3 0.611 Pulmonary embolism 2 0 2 0.599 Ductus thoracicus damage 1 1 0 0.273 Other surgical complication 1 4 3 1 0.060 Other general complication 2 3 2 1 0.179 1. Ileus, hiatus hernia, lymph leakage and acalculous cholecystitis. 2. Pleural effusion, spleen rupture and pneumothorax. Continuous variables (25th – 75th percentile), categorical variables (%) The PEF score was the only significant exposure variable in the analyses of the two Clavien-Dindo groups (p-value 0.013). In the secondary analyses, patients with anastomotic leakage had worse results in the CPET preoperatively (p-value 0.034), whereas performance in the shoulder abduction test was inferior among those who suffered from postoperative pneumonia (p-value 0.043). The results from the main analyses are detailed in Table 2 , and from the secondary analyses in Table 3 . Results from the main univariable logistic analyses revealed no significant results, as shown in Table 4 . Table 2 Absolute numbers Percentage of predicted value (%) All (n = 88) Clavien-Dindo ≥3 (n = 24) Clavien- Dindo < 3 (n = 64) All (n = 88) Clavien-Dindo ≥3 (n = 24) Clavien-Dindo < 3 (n = 64) P-value 6MWT (meters) 500 (436–559) 1 510 (450–587) 495 (427–540) 91.9 (79.8-101.8) 90.4 (77.3-101.4) 92.4 (80-102.3) 0.598 MIP (cm H 2 O) 89 (72–108) 88 (73–107) 89 (72–109) 97.1 (78.9-117.4) 114.8 (82.5-133.2) 96.1 (77.7-113.2) 0.075 MEP (cm H 2 O) 121 (97–141) 115 (96–133) 123 (97–145) 99 (76–115) 97.5 (85.3-124.5) 99 (75–115) 0.768 Grip strength (kg) 41 (36–48) 39 (32–46) 42 (36–50) 106.5 (93.2-125.4) 121.8 (95-137.6) 101.3 (92.3-122.6) 0.195 Shoulder abduction (sec) 60.8 (40–83) 56.1 (30.9–74) 62.6 (40–83) TUG (sec) 6.9 (5.4-8) 7 (6.3–7.8) 6.6 (5.3-8) 128.4 (109.4-154.6) 132.3 (117.3-155.5) 124.3 (101.3-155.9) 0.238 Timed-stands (sec) 22.3 (18-27.4) 23.5 (17.4–30.1) 22 (18-26.2) 84.6 (65.3-104.6) 87.5 (69.9-108.3) 82.1 (62.7-101.6) 0.357 FVC (Liters) 3.1 (2.5–3.7) 3 (2.5–3.4) 3.1 (2.5–3.7) 95.5 (87.5–107) 93.5 (81.5–107) 98 (90-107.8) 0.147 FEV1 (Liters) 2.9 (2.5–3.6) 2.9 (2.2–3.6) 2.9 (2.5–3.7) 96 (86-110.5) 95.2 (89–104) 96.4 (84.3-112.3) 0.739 PEF (liters/min) 483.5 (396.8–580) 449.5 (332.5-551.5) 490 (410.5–586) 105 (396.8–580) 99.5 (332.5-551.5) 110.5 (89-119.8) 0.013 CPET (Watt) 151 (111–183) 151 (120–172) 151 (109–185) Results of the physical examinations Results of the physical tests performed by the patients undergoing esophageal surgery. Results in the left columns are absolute numbers of the test results in the two groups (Clavien-Dindo ≥ 3 and Clavien-Dindo < 3). In the right columns the results are calculated as percentages of the predicted results when using reference values. The percentages are then compared between the two groups. All variables (25th – 75th percentile), median values used. Reference values, taking sex and age into account, were used in all cases except in CPET and shoulder abduction, which are missing reference values. Table 3 Results in the physical examinations and the association to specific complications Pneumonia Sepsis Cardiovascular complications Anastomotic leakage Yes No P-value Yes No P-value Yes No P-value Yes No P-value 6MWT (%) 93 91.7 0.831 94.7 91.6 0.632 106.4 90.4 0.007 88.8 92.3 0.477 TIMED-STANDS (%) 76.5 86.3 0.503 85.4 84.5 0.734 82.5 86.3 0.761 104.2 82.7 0.068 TUG (%) 149.9 122.7 0.092 131.4 126.4 0.988 123.2 128.4 0.490 134.6 124.3 0.908 MIP (%) 122 97.1 0.115 116.8 96.6 0.192 114.8 97.1 0.954 112.9 97 0.155 MEP (%) 104.1 122.7 0.103 118.6 120.9 0.859 122 120 0.903 105.8 123.1 0.085 PEF (%) 88.1 103.8 0.105 108 101.6 0.595 96.3 102.7 0.537 101.3 102.2 0.927 FEV1 (%) 85.6 97.4 0.082 100.2 95.8 0.595 98.9 95.9 0.695 94.8 96.3 0.662 Shoulder abduction (sec) 40 63 0.043 62 60 0.892 60 61 0.950 53 62 0.376 Grip strength (%) 123 109 0.148 92.7 112.3 0.075 125.8 109.2 0.111 110.5 110.7 0.976 Heel-rise (sec) 15.2 12.2 0.090 12.8 12.4 0.353 11 12.6 0.982 12.5 12.5 0.754 Exercise test (Watt) 151 151 0.995 136 153 0.357 177 149 0.183 121.9 155.8 0.034 All tests associated with specific complications after surgery using percentage (%) of predicted value. Shoulder abduction, heel-rise and exercise test do not have any sex- and age-specific reference values. Table 4 Univariate analysis of the results from the physical examinations UNIVARIATE ANALYSIS No. of patients Odds Ratio (95% CI) P-value MIP 88 1.317 (0.507–3.421) 0.572 MEP 88 1.039 (0.400–2.697) 0.938 6MWT 88 2.400 (0.906–6.357) 0.078 Grip strength 88 0.833 (0.317–2.188) 0.711 TUG 88 1.538 (0.392–6.032) 0.537 Timed-stands 88 1.429 (0.495–4.125 ) 0.509 FEV1 88 0.686 (0.255–1.845) 0.455 PEF 88 0.872 (0.334–2.276) 0.779 Sarcopenia 74 1.429 (0.451–4.528) 0.545 Preoperative test results associated with CD≥3 complications. Since no variables were significant in the analysis, a multivariate analysis was not performed. Neither the level of activity nor of sedentary behavior – according to the IPAQ scores – differed between groups. In the secondary analyses, patients suffering from postoperative pneumonia had a trend toward more sedentary behavior (p-value 0.055). The details of the IPAQ form are depicted in Tables 5 and 6 . Table 5 ALL (n = 80) CD≥3 CD < 3 P-VALUE MET-minutes 5811 4684 6210 0.508 Low physical activity ( n ) 15 4 (19%) 10 (18%) 1 Moderate physical activity ( n ) 34 10 (48%) 24 (41%) 0.624 High physical activity ( n ) 31 7 (33%) 24 (41%) 0.622 Sedentary state (hours) 6.2 6.4 6.2 0.811 The association between physical activity and the severity of post operative complications IPAQ results gathered prior to surgery compared between the two groups. The level of activity graded according to IPAQ scoring protocol. IPAQ 4 measures the total time (h) in sedentary state in the last seven days before survey. A MET-minute is created by multiplying the type of activity (walking, moderate and vigorous) with the total time spent on physical activities during a week. For more information, see IPAQ scoring protocol ( 30 ). Table 6 The association between physical activity and specific post operative complications PNEUMONIA SEPSIS CARDIOVASCULAR ANASTOMOTIC LEAKAGE Yes No P-value Yes No P-value Yes No P-value Yes No P-value MET- minutes 11470 5166 0.057 6099 5786 0.933 3829 6009 0.536 6150 5757 0.894 Level of activity (n) Low 2 13 1 3 12 0.93 2 13 0.620 4 11 0.207 Moderate 2 32 0.473 2 32 0.702 3 31 1 3 31 0.356 High 5 26 0.269 31 0 0.091 2 29 0.707 4 27 1 IPAQ 4 (h) 6.46 4.125 0.055 5.383 6.295 0.515 6.714 6.179 0.682 6.367 6.208 0.892 Analysis of results in IPAQ correlation to specific complications. In this cohort, sarcopenia was defined as TPI < 5.53 cm 2 /m 2 for women and < 7.36 cm 2 /m 2 for men ( 22 ). Sarcopenia was present in 21% and 23% of patients with and without severe complications, respectively (p-value 0.588). The presence of sarcopenia did not result in significantly impaired performance in the tests (see Table 7 ). Table 7 The association between results in the physical examination and presence of sarcopenia All (n = 74) Sarcopenia No sarcopenia P-value FVC 99 (90–109) 98 (92–112) 99 (89–109) 0.905 FEV1 95 (25–110) 95 (81–113) 95 (86–109) 0.976 PEF 101 (84–116) 102 (79–112) 100 (84–117) 0.792 MIP 96 (82–120) 105 (96–125) 93 (79–118) 0.202 MEP 99 (85–117) 106 (89–135) 96 (85–113) 0.315 Time-stands 85 (67–104) 91 (70–109) 83 (63–100) 0.225 TUG 134 (114–159) 133 (116–155) 134 (110–160) 0.874 Grip strength 110 (92–126) 122 (105–132) 106 (88–122) 0.025 6MWT 92 (80–102) 94 (82–103) 92 (79–102) 0.648 Comparing percentage of predicted results between patients with sarcopenia prior to surgery (25th – 75th percentile). Only patients with CT scans prior to surgery were included (14 patients missing). DISCUSSION In this multi-center study, we investigated the predictive capabilities of more extensive physical evaluation of the patient regarding the risk of severe complications after esophagectomy for esophageal cancer. Underperformance in spirometry, CPET or shoulder abduction test was associated with a higher incidence of severe postoperative complications. Complications after esophagectomy range from mild pneumonia to life-threatening anastomotic leakage and sepsis. The ability to correctly select patients with a low risk of debilitating or possibly fatal complications is an important task for any multidisciplinary team meeting, but unfortunately the tools available to do so are not well documented. Consequently, the decision on whether the patient will benefit overall from the intervention often relies mainly on clinical experience. PEF performance was 90.5% of predicted value in patients who ultimately suffered from severe postoperative complications, compared with 107% of those who did not. This suggests that decreased air flow is a risk factor for developing postoperative complications. Similar findings have been shown in previous studies regarding pulmonary complications after lobectomy( 32 , 33 ). PEF may be considered a valuable tool in assessing the patient’s pulmonary status. It is also a cheap and efficient test that could be easily integrated into the preoperative workup of the patient’s physical status. Similarly, performance on CPET, a test which is often used to estimate operative risk (although the evidence for predicting complications after esophagectomy is sparse), was worse in patients who later suffered from anastomotic leakage ( 34 ). Several studies have identified a lower VO 2 max preoperatively to be a predictor of overall postoperative complications( 35 , 36 ), while studies specifically examining cardiopulmonary complications have failed to demonstrate any such association( 37 , 38 ). Larger patient cohorts seem to be needed to reach a consensus on the ability of the CPET to predict postoperative complications. In our study, patients with severe complications demonstrated a trend toward a lower level of preoperative physical activity. A small study found a lower level of physical activity to be an independent risk factor for developing postoperative complications after esophagectomy for esophageal cancer( 39 ). The idea that greater physical activity before surgery would lead to fewer postoperative complications seems intuitively reasonable, possibly through a greater reserve capacity. Several studies have shown the potential of prehabilitation in preventing pulmonary complications after surgery( 40 – 42 ), which has led to larger intervention studies on the subject, such as the PREPARE study( 43 ). Starting rehabilitation with a higher level of overall fitness should likely improve the end results. We could not show any association between sarcopenia prior to surgery and the incidence of severe complications postoperatively. Similar results have been described in earlier studies( 44 ), but a larger number of studies have shown positive results, linking sarcopenia to morbidity and mortality after major surgery( 10 , 11 , 22 ). The awareness of sarcopenia and the number of tools to diagnose it have increased in recent years. Grip strength measurements and the TUG test have shown potential in diagnosing sarcopenia and are also recommended in the most recent guidelines( 45 , 46 ). In our study, we were also unable to confirm any association between these tests and sarcopenia. However, this study was not designed to establish such an association; the reference values linked to grip strength and TUG listed in the guidelines differ from the test results in this study, which might indicate a difficulty in using the proposed reference values on a group already selected for surgery. Strengths and limitations This is a multi-center study with reliable data, either gathered by the authors or obtained from a validated register( 47 ). The included patients constitute a population-based cohort for Sweden’s three largest university hospitals’ catchment areas, corroborated by the fact that demographic data are similar to data reported in NREV( 48 ). All tests included in the analyses are standardized, validated and reliable, making the methods easy to replicate in future studies. Every center assigned the same detailed manual to each test, which makes the results comparable between centers. Furthermore, reference values, adjusted for sex and age, were used for 6MWT, MIP, MEP and grip strength, TUG, timed-stands and FVC, FEV1 and PEF, making comparisons between groups more representable. All tests used in this study are easy to perform and require almost no extra equipment for the physiotherapist, making them easy to introduce into clinical practice. Many of the tests were performed not more than 10 days prior to surgery. Except for CPET and spirometry, no additional testing was performed before neoadjuvant oncological therapy. The neoadjuvant therapy often leads to deteriorating physical fitness. If the same tests were performed before the neoadjuvant treatment started, it would be possible to compare the test results and identify the patients with the greatest decline, using patients as their own references, which could be of clinical importance. Similarly, the CT scans used to identify sarcopenia in this study were all performed prior to neoadjuvant therapy. Elliot et al demonstrated a 15% increase in sarcopenia during neoadjuvant oncological therapy, indicating that sarcopenia may be more prevalent among patients undergoing surgery than has been previously understood( 49 ). Due to the overall lack of earlier studies on the predictive capabilities of phyiscal tests for postoperative complications after esophagectomy, this study was designed as an explorative, hypothesis-generating study. We therefore chose to include several different tests in the study design, in search of results promising enough to motivate further studies on this subject. Esophagectomy is a rather uncommon procedure, yielding small cohorts overall, and even though we have included patients from the three largest catchment areas in Sweden, the study still risks being underpowered overall, and does not allow for adjusting for confounders in multivariable analyses. CONCLUSION This small, explorative, hypothesis-generating study has shown a potential benefit of using some cheap and easily replicable physical tests to determine the overall risk of curative surgery for esophageal cancer. With a greater understanding of the individual patient’s physical preoperative condition, we may be able to identify patients with a higher risk of a complicated course postoperatively, and hopefully better select, inform, and optimize patients before they undergo surgery that, while designed to cure them, might instead harm them. Declarations Ethics approval and consent to participate Ethical approval for collecting data were acquired from Regionala Etikprövningsnämnden (EPN). Number of approval: 1028-13. All patients in the study did consent to participate in this study and left a written and informed consent. Consent for publication Not applicable Availability of data and materials The datasets generated and/or analysed during the current study are not publicly available due to patient secrecy but are available from the corresponding author on reasonable request. Funding Work was supported by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (ALFGBG-718811). References Norr RC. Matstrups- och ventrikelcancer. Nationellt vårdprogram 2019 [Available from: https://cancercentrum.se/samverkan/cancerdiagnoser/matstrupe-och-magsack/vardprogram/. Goense L, van Dijk WA, Govaert JA, van Rossum PS, Ruurda JP, van Hillegersberg R. Hospital costs of complications after esophagectomy for cancer. Eur J Surg Oncol. 2016. Jiang H, Hua R, Sun Y, Guo X, Liu Z, Su Y, et al. Risk Factors for Anastomotic Complications After Radical McKeown Esophagectomy. Ann Thorac Surg. 2021;112(3):944-51. Aoyama T, Atsumi Y, Hara K, Tamagawa H, Tamagawa A, Komori K, et al. Risk Factors for Postoperative Anastomosis Leak After Esophagectomy for Esophageal Cancer. In Vivo. 2020;34(2):857-62. Steyerberg EW, Neville B, Weeks JC, Earle CC. Referral Patterns, Treatment Choices, and Outcomes in Locoregional Esophageal Cancer: A Population-Based Analysis of Elderly Patients. Journal of Clinical Oncology. 2007;25(17):2389-96. Hagens ERC, Reijntjes MA, Anderegg MCJ, Eshuis WJ, Van Berge Henegouwen MI, Gisbertz SS. Risk Factors and Consequences of Anastomotic Leakage After Esophagectomy for Cancer. The Annals of Thoracic Surgery. 2021;112(1):255-63. Ohi M, Toiyama Y, Omura Y, Ichikawa T, Yasuda H, Okugawa Y, et al. Risk factors and measures of pulmonary complications after thoracoscopic esophagectomy for esophageal cancer. Surgery Today. 2019;49(2):176-86. Kassis ES, Kosinski AS, Ross P, Koppes KE, Donahue JM, Daniel VC. Predictors of Anastomotic Leak After Esophagectomy: An Analysis of The Society of Thoracic Surgeons General Thoracic Database. The Annals of Thoracic Surgery. 2013;96(6):1919-26. Boutin RD, Yao L, Canter RJ, Lenchik L. Sarcopenia: Current Concepts and Imaging Implications. AJR Am J Roentgenol. 2015;205(3):W255-66. Deng HY, Zha P, Peng L, Hou L, Huang KL, Li XY. Preoperative sarcopenia is a predictor of poor prognosis of esophageal cancer after esophagectomy: a comprehensive systematic review and meta-analysis. Dis Esophagus. 2018. Koch C, Reitz C, Schreckenbach T, Eichler K, Filmann N, Al-Batran S-E, et al. Sarcopenia as a prognostic factor for survival in patients with locally advanced gastroesophageal adenocarcinoma. PLOS ONE. 2019;14(10):e0223613. Inoue T, Ito S, Ando M, Nagaya M, Aso H, Mizuno Y, et al. Changes in exercise capacity, muscle strength, and health-related quality of life in esophageal cancer patients undergoing esophagectomy. BMC Sports Sci Med Rehabil. 2016;8:34. Keeratichananont W, Thanadetsuntorn C, Keeratichananont S. Value of preoperative 6-minute walk test for predicting postoperative pulmonary complications. Therapeutic advances in respiratory disease. 2016;10(1):18-25. Whibley J, Peters CJ, Halliday LJ, Chaudry AM, Allum WH. Poor performance in incremental shuttle walk and cardiopulmonary exercise testing predicts poor overall survival for patients undergoing esophago-gastric resection. Eur J Surg Oncol. 2018;44(5):594-9. Bolger JC, Loughney L, Tully R, Cunningham M, Keogh S, McCaffrey N, et al. Perioperative prehabilitation and rehabilitation in esophagogastric malignancies: a systematic review. Diseases of the Esophagus. 2019;32(9). Feeney C, Reynolds JV, Hussey J. Preoperative physical activity levels and postoperative pulmonary complications post-esophagectomy. Dis Esophagus. 2011;24(7):489-94. Doganay E, Moorthy K. Prehabilitation for esophagectomy. Journal of Thoracic Disease. 2019;11(S5):S632-S8. Levett DZH, Jack S, Swart M, Carlisle J, Wilson J, Snowden C, et al. Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation. Br J Anaesth. 2018;120(3):484-500. Quanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Eur Respir J. 1993;6 Suppl 16:5-40. Liou TG, Kanner RE. Spirometry. Clin Rev Allergy Immunol. 2009;37(3):137-52. Xu J-Y, Li C, Zhang H, Liu Y, Wei J-M. Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy. Risk Management and Healthcare Policy. 2020;Volume 13:761-70. Rangel EL, Rios-Diaz AJ, Uyeda JW, Castillo-Angeles M, Cooper Z, Olufajo OA, et al. Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery. J Trauma Acute Care Surg. 2017;83(6):1179-86. Smyth RJ, Chapman KR, Rebuck AS. Maximal Inspiratory and Expiratory Pressures in Adolescents. None. 1984;86(4). Backman E, Johansson V, Hager B, Sjoblom P, Henriksson KG. Isometric muscle strength and muscular endurance in normal persons aged between 17 and 70 years. Scand J Rehabil Med. 1995;27(2):109-17. Cider Å, Carlsson S, Arvidsson C, Andersson B, Stibrant Sunnerhagen K. Reliability of Clinical Muscular Endurance Tests in Patients with Chronic Heart Failure. European Journal of Cardiovascular Nursing. 2006;5(2):122-6. Podsiadlo D, Richardson S. The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons1991. 142-8 p. Csuka M, McCarty DJ. Simple method for measurement of lower extremity muscle strength. The American Journal of Medicine. 1985;78(1). Rae Lunsford B, Perry J. The Standing Heel-Rise Test for Ankle Plantar Flexion: Criterion for Normal1995. 694-8 p. Craig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381-95. IPAQ. Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ). 2005. Linder G, Lindblad M, Djerf P, Elbe P, Johansson J, Lundell L, et al. Validation of data quality in the Swedish National Register for Oesophageal and Gastric Cancer. Br J Surg. 2016;103(10):1326-35. Lai Y, Wang X, Li P, Li J, Zhou K, Che G. Preoperative peak expiratory flow (PEF) for predicting postoperative pulmonary complications after lung cancer lobectomy: a prospective study with 725 cases. Journal of Thoracic Disease. 2018;10(7):4293-301. Zhou K, Wu Y, Su J, Lai Y, Shen C, Li P, et al. [Can Preoperative Peak Expiratory Flow Predict Postoperative Pulmonary Complications in Lung Cancer Patients Undergoing Lobectomy?]. Zhongguo Fei Ai Za Zhi. 2017;20(9):603-9. Liedman BL, Bennegård K, Olbe LC, Lundell LR. Predictors of postoperative morbidity and mortality after surgery for gastro-oesophageal carcinomas. Eur J Surg. 1995;161(3):173-80. Patel N, Powell AG, Wheat JR, Brown C, Appadurai IR, Davies RG, et al. Cardiopulmonary fitness predicts postoperative major morbidity after esophagectomy for patients with cancer. Physiological Reports. 2019;7(14). Nagamatsu Y, Shima I, Yamana H, Fujita H, Shirouzu K, Ishitake T. Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus. J Thorac Cardiovasc Surg. 2001;121(6):1064-8. Moyes LH, McCaffer CJ, Carter RC, Fullarton GM, Mackay CK, Forshaw MJ. Cardiopulmonary exercise testing as a predictor of complications in oesophagogastric cancer surgery. Ann R Coll Surg Engl. 2013;95(2):125-30. Lam S, Alexandre L, Hardwick G, Hart AR. The association between preoperative cardiopulmonary exercise–test variables and short-term morbidity after esophagectomy: A hospital-based cohort study. Surgery. 2019;166(1):28-33. Noriatsu Tatematsu1* MP, Eiji Tanaka2, Yoshiharu Sakai2, Tadao Tsuboyama1. Association between Physical Activity and Postoperative Complications after Esophagectomy for Cancer: A Prospective Observational Study. 2013. Soares SM, Nucci LB, da Silva MM, Campacci TC. Pulmonary function and physical performance outcomes with preoperative physical therapy in upper abdominal surgery: a randomized controlled trial. Clin Rehabil. 2013;27(7):616-27. Hulzebos EHJ, Helders PJM, Favié NJ, De Bie RA, Brutel De La Riviere A, Van Meeteren NLU. Preoperative Intensive Inspiratory Muscle Training to Prevent Postoperative Pulmonary Complications in High-Risk Patients Undergoing CABG Surgery. JAMA. 2006;296(15):1851. Kendall F, Oliveira J, Peleteiro B, Pinho P, Bastos PT. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: a systematic review and meta-analysis. Disability and Rehabilitation. 2018;40(8):864-82. Valkenet K, Trappenburg JC, Gosselink R, Sosef MN, Willms J, Rosman C, et al. Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): study protocol for a randomized controlled trial. Trials. 2014;15(1):144. Grotenhuis BA, Shapiro J, van Adrichem S, de Vries M, Koek M, Wijnhoven BP, et al. Sarcopenia/Muscle Mass is not a Prognostic Factor for Short- and Long-Term Outcome After Esophagectomy for Cancer. World J Surg. 2016;40(11):2698-704. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. Cruz-Jentoft AJ, Sayer AA. Sarcopenia. The Lancet. 2019;393(10191):2636-46. Goense L, van Rossum PS, Tromp M, Joore HC, van Dijk D, Kroese AC, et al. Intraoperative and postoperative risk factors for anastomotic leakage and pneumonia after esophagectomy for cancer. Dis Esophagus. 2016. Nord R. NREV årsrapport. 2020. Elliott JA, Doyle SL, Murphy CF, King S, Guinan EM, Beddy P, et al. Sarcopenia: Prevalence, and Impact on Operative and Oncologic Outcomes in the Multimodal Management of Locally Advanced Esophageal Cancer. Ann Surg. 2017;266(5):822-30. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3866057","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":269660649,"identity":"2b5bf727-e3e8-4a01-9657-86df4f2653b9","order_by":0,"name":"Erik Nilsson","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArklEQVRIiWNgGAWjYJCCAx//2ZCmg/HhDLY00rQwG/OwHSZBPb907zHJGTzn8w1uNzB/+ECMFsk559IkPkjcttxw5wCb5AxitBjcyDGTnGFw20ByRgIbMw8xWuyBWqR5Es6BtDB//kOULRI5xsY8Bw4Y8EskMEgTo4NB4kaO4cOZDclALYltkj3EaOGfkWNw4GODnQGbRPLhDz+IsgYBGBtI1DAKRsEoGAWjACcAAIENL7Q+7dS3AAAAAElFTkSuQmCC","orcid":"","institution":"Örnsköldsvik Hospital","correspondingAuthor":true,"prefix":"","firstName":"Erik","middleName":"","lastName":"Nilsson","suffix":""},{"id":269660650,"identity":"21f7c801-1602-4ede-8cf3-38a9b995feb6","order_by":1,"name":"Monika Fagevik Olsén","email":"","orcid":"","institution":"University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Monika","middleName":"Fagevik","lastName":"Olsén","suffix":""},{"id":269660651,"identity":"dfdf8061-0386-4bed-971e-f29e2c898c6f","order_by":2,"name":"Petrus Boström","email":"","orcid":"","institution":"University Hospital of Umeå","correspondingAuthor":false,"prefix":"","firstName":"Petrus","middleName":"","lastName":"Boström","suffix":""},{"id":269660652,"identity":"66a2c0ad-aad2-4f6f-afd7-fec063aedd56","order_by":3,"name":"Ulrika Trolle","email":"","orcid":"","institution":"Lund University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ulrika","middleName":"","lastName":"Trolle","suffix":""},{"id":269660653,"identity":"ab94a21c-4852-49b6-a960-b9e906de4b30","order_by":4,"name":"Frances Eriksson","email":"","orcid":"","institution":"Karolinska University","correspondingAuthor":false,"prefix":"","firstName":"Frances","middleName":"","lastName":"Eriksson","suffix":""},{"id":269660654,"identity":"543fb454-d347-4171-8ecf-7547c0e432f4","order_by":5,"name":"Suada Becovic","email":"","orcid":"","institution":"University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Suada","middleName":"","lastName":"Becovic","suffix":""},{"id":269660655,"identity":"928bdeaf-ed58-4baf-991f-fbbc7673bb17","order_by":6,"name":"Michael Hermansson","email":"","orcid":"","institution":"Lund University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Hermansson","suffix":""}],"badges":[],"createdAt":"2024-01-15 09:44:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3866057/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3866057/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51426339,"identity":"639fba84-f221-4c10-a4d9-ca6c0f4e8614","added_by":"auto","created_at":"2024-02-21 11:38:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":480991,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3866057/v1/9cf55420-6a4e-40c8-90a9-04ea678ffd50.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prediction of morbidity and mortality after thoracoabdominal esophageal surgery","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eIn Sweden, patients undergoing surgery for esophageal cancer usually receive perioperative chemotherapy or neoadjuvant radiochemotherapy(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This extensive oncological treatment and major surgery is associated with high morbidity, especially in elderly patients and those with significant comorbidities and poor physical status (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In addition, dysphagia and cancer cachexia often result in considerable weight loss at the time of diagnosis, adding to the risk of complications (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Even for patients with resectable tumors, only 34% undergo treatment with curative intent, illustrating the emphasis on patient selection(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In Sweden, we regularly use spirometry and submaximal exercise testing to complement the clinician\u0026rsquo;s physical examination.\u003c/p\u003e \u003cp\u003eSeveral risk factors regarding postoperative complications after esophagectomy have been established, including age, BMI, and chronic obstructive pulmonary disease and sarcopenia, the latter also associated with decreased survival after surgery(\u003cspan additionalcitationids=\"CR7 CR8 CR9 CR10\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). However, improved physical tests could potentially help determine the individual\u0026rsquo;s overall operability and hence determine treatment recommendations. Several tests have shown the potential to determine the patient\u0026rsquo;s cardiovascular health, general fitness and pulmonary capabilities(\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Studies have also shown promising effects of preoperative prehabilitation(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Higher preoperative physical activity levels seem to decrease pulmonary complications(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), and prehabilitation, focusing on inspiratory muscle training and exercise, has been shown to reduce postoperative complications and decrease the length of the hospital stay(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe aim of this study was to evaluate whether reliable and valid tests of physical strength and stamina could be used as predictors of morbidity and mortality after thoracoabdominal esophageal cancer surgery.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003ePatients who were due to undergo thoracic abdominal esophagectomy between September 2014 and February 2017 at Sahlgrenska University Hospital, Lund University Hospital or Karolinska University Hospital were asked for their written consent to be enrolled in the study, after receiving appropriate verbal and written information. Inclusion criteria were a planned esophagectomy for cancer and an age of over 18 years. Prior to surgery, the patients met a physiotherapist to perform eight clinically relevant and standardized physical tests, carried out not more than 10 days prior to surgery, with the aim of assessing their cardiopulmonary status and stamina. Patients also completed the mandatory submaximal cardiopulmonary exercise test (CPET)(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) and spirometry, where Peak Expiratory Flow (PEF)(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and Forced Expiratory Volume (FEV1)(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) was measured.\u003c/p\u003e \u003cp\u003eCT images produced prior to treatment decision were gathered and the total psoas area (TPA)(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) was calculated at level L4 by an experienced radiologist. The TPA was then used to calculate the total psoas index (TPI\u0026thinsp;=\u0026thinsp;TPA/height\u003csup\u003e2\u003c/sup\u003e, cm\u003csup\u003e2\u003c/sup\u003e/m\u003csup\u003e2\u003c/sup\u003e), which in turn was compared between groups and, in further analysis, divided into quartiles. Sarcopenia was defined as TPI in the lowest sex-specific quartile(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe primary outcome of this study was the presence of any severe complication after surgery, defined as Clavien-Dindo (CD)\u0026thinsp;\u0026ge;\u0026thinsp;3. The performance in the physical tests, and the presence of sarcopenia, were used as exposure variables, and the associations between the preoperative test results and postoperative complications evaluated. The same analyses were then performed using specific postoperative complications as secondary outcomes: i) anastomotic leakage, ii) bacterial pneumonia, iii) cardiovascular complications, and iv) sepsis.\u003c/p\u003e \u003cp\u003ePhysical tests\u003c/p\u003e \u003cp\u003eThe following seven physical tests used in the study are methods of examining cardiopulmonary fitness, muscle stamina and general fitness: \u003cem\u003eThe six-minute walk distance test (6MWD)\u003c/em\u003e measured the total length a patient was able to walk (meters) in six minutes on a 30-meter-long course(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). \u003cem\u003eMaximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP)\u003c/em\u003e were measured with a \u003cem\u003eMicroRPM\u003c/em\u003e \u0026trade; (Respiratory Pressure Meter: Care Fusion, Sollentuna, Sweden) according to international guidelines. Three attempts were made, and the patient was instructed to exhale and inhale with maximum strength after a maximal inspiration and expiration, respectively (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). \u003cem\u003eIsometric grip strength\u003c/em\u003e of the dominant hand was measured using a hand dynamometer (\u003cem\u003eJamar dynamometer, Patterson Medical\u003c/em\u003e \u0026reg;), while the patient was sitting upright in a chair with his/her arm resting on the armrest(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). We carried out three tests, and the highest value was recorded. \u003cem\u003eThe shoulder abduction test\u003c/em\u003e was conducted with the patient standing. They were instructed to abduct their shoulders to 90\u0026ordm; and hold them as long as possible with weights in his/her hands (2 x 2 kg for women, 2 x 3 kg for men). We allowed a single correction of technique if the arms were seen to be dropping, and the duration of abduction was recorded(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). \u003cem\u003eThe timed up and go (TUG)\u003c/em\u003e test started with the patient seated in a chair. When the timer started, they were instructed to rise from the chair, walk three meters, turn and then return to the chair and sit down, and the time required for the full motion was recorded(\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). \u003cem\u003eA timed-stands test\u003c/em\u003e measured the total time it took the patient to stand up and sit down 10 times from a standardized chair with a height of 46 cm, without any support from the arms(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). \u003cem\u003eThe heel-raise test\u003c/em\u003e measured the amount of time necessary for the patient to perform 10 maximal heel raises as quickly as possible, allowing the arms to be used for support. This test had been modified from the original(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition, patients filled out the International Physical Activity Questionnaire (IPAQ) short form(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), a questionnaire regarding self-assessed physical activity level. It includes questions about time spent being physically active at vigorous and moderate levels, and time spent walking during the last seven days. It also includes a question concerning time spent sitting during the same period. In the study, a total weekly MET level was calculated, according to guidelines, by multiplying the reported minutes per week in each category by 3.3 for low-intensity activity, 4.0 for moderate-intensity activity, and 8.0 for vigorous-intensity activity(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). The scores from these three categories were consolidated into a total MET-minutes-per-week score, which was categorized into three levels of physical activity, graded \u0026lsquo;low\u0026rsquo;, \u0026lsquo;moderate\u0026rsquo;, and \u0026lsquo;high\u0026rsquo;. Results from the physical tests and the IPAQ results were gathered on site by the responsible physiotherapist.\u003c/p\u003e \u003cp\u003eEpidemiological data\u003c/p\u003e \u003cp\u003ePre-, peri- and postoperative data were gathered from patient case-records and National Register of Esophagus and Ventricle cancer (NREV), a register with reliable and comparable data(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The register contributed with the following variables: weight, height, smoking habits, American Society of Anesthesiologists (ASA) score, Zubrod score (WHO score), preoperative chemo- or chemoradiation therapy, perioperative bleeding, length of surgery, localization of the tumor, technique for creating the anastomosis, level of the anastomosis, days in hospital, surgical complications, general complications, Clavien-Dindo classification of the most severe complication, histological type, and tumor-free margins.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables were first analyzed to determine whether the data was normally distributed. Normally distributed variables were then evaluated using the student\u0026rsquo;s t-test, and non-normal variables using the Mann-Whitney U test. The chi-squared test or Fisher\u0026rsquo;s exact test were used for comparing categorical variables. Univariable logistic regression analyses were used to examine the association between exposures and outcomes, and the study was designed to perform a multiple logistic regression using only significant results from the univariable analyses. A two-tailed p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant. All statistical analyses were performed using SPSS (IBM SPSS Statistics for Macintosh, Version 25.0).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 114 patients were enrolled in the study. Seven patients were excluded due to metastatic disease, 11 patients due to no esophagectomy being performed, and eight patients for whom no data were found in the register. Altogether, 88 patients were included in the analyses. In this cohort, 24 patients had severe postoperative complications. Thirty\u0026ndash;day mortality was zero, but two patients died within 90 postoperative days.\u003c/p\u003e \u003cp\u003eDemographic and complication data are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of patients included in the study was 66 years, a majority was male (81%), with a mean body mass index of 26.2 kg/m2, with no significant differences between the two groups. Most patients were diagnosed with adenocarcinoma (80%). Eight patients who were eligible for surgery had an ASA score 3, with the rest either ASA 1 (51%) or ASA 2 (40%). 52% received neoadjuvant radio chemotherapy and 77% perioperative chemotherapy. Patients with severe complications had a longer hospital stay (24 vs 12 days, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.005). Overall, the most common complication was anastomotic leakage, followed by bacterial pneumonia, cardiovascular complications, and sepsis.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the 88 patients undergoing esophageal surgery\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClavien-Dindo \u0026ge;3 (n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eClavien- Dindo\u0026thinsp;\u0026lt;\u0026thinsp;3 (n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSex (male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55 (86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (60\u0026ndash;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (61\u0026ndash;72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (60\u0026ndash;71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.893\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.2 (23.8\u0026ndash;28.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.5 (24.4\u0026ndash;29.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.9 (23.1\u0026ndash;28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eHistology\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70 (80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48 (75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSquamous cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.559\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eASA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.206\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTotal psoas index (cm\u003csup\u003e2\u003c/sup\u003e/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.2 (6.6\u0026ndash;9.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.8 (6.3\u0026ndash;10.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.4 (6.7\u0026ndash;9.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.634\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSarcopenia prior to surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.606\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNeoadjuvant chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49 (77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNeoadjuvant radiochemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e46 (52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePerioperative bleeding (ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e300 (200\u0026ndash;575)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e300 (75\u0026ndash;600)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e300 (200\u0026ndash;500)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTime surgery (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e469 (405\u0026ndash;570)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e443 (353\u0026ndash;550)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e474 (413\u0026ndash;570)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.843\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eLevel of anastomosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInferior pulmonary vein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVena azygos\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57 (65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17 (71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.617\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApex of the chest\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDays in hospital (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (10\u0026ndash;21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (14\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (9\u0026ndash;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e90-day mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eComplications post surgery\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGeneral complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSurgical complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eAnastomotic leakage\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eBacterial pneumonia\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eCardiovascular complications\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.678\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSepsis\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003en. recurrens damage\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePulmonary embolism\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.599\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eDuctus thoracicus damage\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.273\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOther surgical complication\u003c/em\u003e\u003csup\u003e\u003cem\u003e1\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOther general complication\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e1. Ileus, hiatus hernia, lymph leakage and acalculous cholecystitis.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e2. Pleural effusion, spleen rupture and pneumothorax.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eContinuous variables (25th \u0026ndash; 75th percentile), categorical variables (%)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe PEF score was the only significant exposure variable in the analyses of the two Clavien-Dindo groups (p-value 0.013). In the secondary analyses, patients with anastomotic leakage had worse results in the CPET preoperatively (p-value 0.034), whereas performance in the shoulder abduction test was inferior among those who suffered from postoperative pneumonia (p-value 0.043). The results from the main analyses are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, and from the secondary analyses in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Results from the main univariable logistic analyses revealed no significant results, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eAbsolute numbers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c8\" namest=\"c5\"\u003e \u003cp\u003ePercentage of predicted value (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClavien-Dindo\u003c/p\u003e \u003cp\u003e\u0026ge;3\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eClavien- Dindo\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;88)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eClavien-Dindo\u003c/p\u003e \u003cp\u003e\u0026ge;3\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClavien-Dindo\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6MWT\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(meters)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e500 (436\u0026ndash;559)\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e510 (450\u0026ndash;587)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e495 (427\u0026ndash;540)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91.9 (79.8-101.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90.4 (77.3-101.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e92.4 (80-102.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMIP (cm H\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003eO)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89 (72\u0026ndash;108)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (73\u0026ndash;107)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89 (72\u0026ndash;109)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97.1 (78.9-117.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e114.8 (82.5-133.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e96.1 (77.7-113.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMEP (cm H\u003c/b\u003e\u003csup\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sup\u003e\u003cb\u003eO)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e121 (97\u0026ndash;141)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115 (96\u0026ndash;133)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e123 (97\u0026ndash;145)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99 (76\u0026ndash;115)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e97.5 (85.3-124.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e99 (75\u0026ndash;115)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrip strength (kg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (36\u0026ndash;48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (32\u0026ndash;46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (36\u0026ndash;50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e106.5 (93.2-125.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e121.8 (95-137.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e101.3 (92.3-122.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eShoulder abduction (sec)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.8 (40\u0026ndash;83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56.1 (30.9\u0026ndash;74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.6 (40\u0026ndash;83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTUG (sec)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.9 (5.4-8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (6.3\u0026ndash;7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.6 (5.3-8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e128.4 (109.4-154.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e132.3 (117.3-155.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e124.3 (101.3-155.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTimed-stands (sec)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.3 (18-27.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.5 (17.4\u0026ndash;30.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22 (18-26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.6 (65.3-104.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e87.5 (69.9-108.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e82.1 (62.7-101.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.357\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFVC (Liters)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.1 (2.5\u0026ndash;3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (2.5\u0026ndash;3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.1 (2.5\u0026ndash;3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95.5 (87.5\u0026ndash;107)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e93.5 (81.5\u0026ndash;107)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e98 (90-107.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFEV1 (Liters)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.9 (2.5\u0026ndash;3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.9 (2.2\u0026ndash;3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.9 (2.5\u0026ndash;3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96 (86-110.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95.2 (89\u0026ndash;104)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e96.4 (84.3-112.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.739\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePEF (liters/min)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e483.5 (396.8\u0026ndash;580)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e449.5 (332.5-551.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e490 (410.5\u0026ndash;586)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105 (396.8\u0026ndash;580)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e99.5 (332.5-551.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e110.5 (89-119.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCPET (Watt)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151 (111\u0026ndash;183)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151 (120\u0026ndash;172)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151 (109\u0026ndash;185)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eResults of the physical examinations\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eResults of the physical tests performed by the patients undergoing esophageal surgery.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eResults in the left columns are absolute numbers of the test results in the two groups (Clavien-Dindo \u003cb\u003e\u0026ge;\u003c/b\u003e3 and Clavien-Dindo\u0026thinsp;\u0026lt;\u0026thinsp;3). In the right columns the results are calculated as percentages of the predicted results when using reference values. The percentages are then compared between the two groups.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eAll variables (25th \u0026ndash; 75th percentile), median values used. Reference values, taking sex and age into account, were used in all cases except in CPET and shoulder abduction, which are missing reference values.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults in the physical examinations and the association to specific complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eSepsis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003eCardiovascular complications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003eAnastomotic leakage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6MWT (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.831\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e91.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.632\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e106.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e90.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e88.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e92.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.477\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTIMED-STANDS (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.503\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e85.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e84.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.734\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e82.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e86.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.761\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e104.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e82.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.068\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTUG (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.092\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e131.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e126.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.988\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e123.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e128.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.490\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e134.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e124.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.908\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMIP (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.115\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e116.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e96.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.192\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e114.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e97.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.954\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e112.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.155\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMEP (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.103\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e118.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e120.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.859\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.903\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e105.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e123.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.085\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePEF (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.105\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e101.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.595\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e96.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e102.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.537\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e101.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e102.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.927\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFEV1 (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.082\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.595\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e98.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e95.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.695\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e94.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e96.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.662\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eShoulder abduction (sec)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.043\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.892\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.950\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.376\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrip strength (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.148\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e92.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e112.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.075\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e125.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e109.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.111\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e110.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e110.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.976\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHeel-rise (sec)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.090\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.353\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.982\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.754\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eExercise test (Watt)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.995\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.357\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cem\u003e0.183\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e121.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e155.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.034\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eAll tests associated with specific complications after surgery using percentage (%) of predicted value. Shoulder abduction, heel-rise and exercise test do not have any sex- and age-specific reference values.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnivariate analysis of the results from the physical examinations\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eUNIVARIATE ANALYSIS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds Ratio (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMIP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.317 (0.507\u0026ndash;3.421)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.572\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMEP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.039 (0.400\u0026ndash;2.697)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.938\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6MWT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.400 (0.906\u0026ndash;6.357)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrip strength\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.833 (0.317\u0026ndash;2.188)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTUG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.538 (0.392\u0026ndash;6.032)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTimed-stands\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.429 (0.495\u0026ndash;4.125 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFEV1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.686 (0.255\u0026ndash;1.845)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.455\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePEF\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.872 (0.334\u0026ndash;2.276)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.779\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSarcopenia\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.429 (0.451\u0026ndash;4.528)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003ePreoperative test results associated with CD\u0026ge;3 complications. Since no variables were significant in the analysis, a multivariate analysis was not performed.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNeither the level of activity nor of sedentary behavior \u0026ndash; according to the IPAQ scores \u0026ndash; differed between groups. In the secondary analyses, patients suffering from postoperative pneumonia had a trend toward more sedentary behavior (p-value 0.055). The details of the IPAQ form are depicted in Tables\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e\u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eALL (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCD\u0026ge;3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCD\u0026thinsp;\u0026lt;\u0026thinsp;3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-VALUE\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMET-minutes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4684\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.508\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLow physical activity (\u003c/b\u003e\u003cb\u003en\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eModerate physical activity (\u003c/b\u003e\u003cb\u003en\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.624\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHigh physical activity (\u003c/b\u003e\u003cb\u003en\u003c/b\u003e\u003cb\u003e)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.622\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSedentary state (hours)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.811\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eThe association between physical activity and the severity of post operative complications\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIPAQ results gathered prior to surgery compared between the two groups.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eThe level of activity graded according to IPAQ scoring protocol. IPAQ 4 measures the total time (h) in sedentary state in the last seven days before survey.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cem\u003eA MET-minute is created by multiplying the type of activity (walking, moderate and vigorous) with the total time spent on physical activities during a week. For more information, see IPAQ scoring protocol\u003c/em\u003e (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe association between physical activity and specific post operative complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePNEUMONIA\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSEPSIS\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCARDIOVASCULAR\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eANASTOMOTIC LEAKAGE\u003c/span\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eP-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003eP-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003eP-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003eYes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003eP-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMET- minutes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.057\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6099\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.933\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.536\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.894\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"ItalicUnderline\" class=\"ItalicUnderline\" name=\"Emphasis\"\u003eLevel of activity (n)\u003c/span\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.93\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.207\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.473\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.702\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.356\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.269\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.091\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.707\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e1\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIPAQ 4 (h)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.055\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.295\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003e0.515\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e6.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.682\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6.367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cem\u003e0.892\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eAnalysis of results in IPAQ correlation to specific complications.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn this cohort, sarcopenia was defined as TPI\u0026thinsp;\u0026lt;\u0026thinsp;5.53 cm\u003csup\u003e2\u003c/sup\u003e/m\u003csup\u003e2\u003c/sup\u003e for women and \u0026lt;\u0026thinsp;7.36 cm\u003csup\u003e2\u003c/sup\u003e/m\u003csup\u003e2\u003c/sup\u003e for men (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Sarcopenia was present in 21% and 23% of patients with and without severe complications, respectively (p-value 0.588). The presence of sarcopenia did not result in significantly impaired performance in the tests (see Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe association between results in the physical examination and presence of sarcopenia\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll (n\u0026thinsp;=\u0026thinsp;74)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSarcopenia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo sarcopenia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFVC\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (90\u0026ndash;109)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (92\u0026ndash;112)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99 (89\u0026ndash;109)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.905\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFEV1\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (25\u0026ndash;110)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (81\u0026ndash;113)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (86\u0026ndash;109)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.976\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePEF\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e101 (84\u0026ndash;116)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (79\u0026ndash;112)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100 (84\u0026ndash;117)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.792\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMIP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e96 (82\u0026ndash;120)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (96\u0026ndash;125)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (79\u0026ndash;118)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.202\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMEP\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99 (85\u0026ndash;117)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (89\u0026ndash;135)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96 (85\u0026ndash;113)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.315\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTime-stands\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e85 (67\u0026ndash;104)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (70\u0026ndash;109)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (63\u0026ndash;100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.225\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTUG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134 (114\u0026ndash;159)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133 (116\u0026ndash;155)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134 (110\u0026ndash;160)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.874\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrip strength\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e110 (92\u0026ndash;126)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e122 (105\u0026ndash;132)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106 (88\u0026ndash;122)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003e6MWT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92 (80\u0026ndash;102)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (82\u0026ndash;103)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92 (79\u0026ndash;102)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003e0.648\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eComparing percentage of predicted results between patients with sarcopenia prior to surgery (25th \u0026ndash; 75th percentile). Only patients with CT scans prior to surgery were included (14 patients missing).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this multi-center study, we investigated the predictive capabilities of more extensive physical evaluation of the patient regarding the risk of severe complications after esophagectomy for esophageal cancer. Underperformance in spirometry, CPET or shoulder abduction test was associated with a higher incidence of severe postoperative complications.\u003c/p\u003e \u003cp\u003eComplications after esophagectomy range from mild pneumonia to life-threatening anastomotic leakage and sepsis. The ability to correctly select patients with a low risk of debilitating or possibly fatal complications is an important task for any multidisciplinary team meeting, but unfortunately the tools available to do so are not well documented. Consequently, the decision on whether the patient will benefit overall from the intervention often relies mainly on clinical experience.\u003c/p\u003e \u003cp\u003ePEF performance was 90.5% of predicted value in patients who ultimately suffered from severe postoperative complications, compared with 107% of those who did not. This suggests that decreased air flow is a risk factor for developing postoperative complications. Similar findings have been shown in previous studies regarding pulmonary complications after lobectomy(\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). PEF may be considered a valuable tool in assessing the patient\u0026rsquo;s pulmonary status. It is also a cheap and efficient test that could be easily integrated into the preoperative workup of the patient\u0026rsquo;s physical status.\u003c/p\u003e \u003cp\u003eSimilarly, performance on CPET, a test which is often used to estimate operative risk (although the evidence for predicting complications after esophagectomy is sparse), was worse in patients who later suffered from anastomotic leakage (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Several studies have identified a lower VO\u003csub\u003e2\u003c/sub\u003e max preoperatively to be a predictor of overall postoperative complications(\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), while studies specifically examining cardiopulmonary complications have failed to demonstrate any such association(\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Larger patient cohorts seem to be needed to reach a consensus on the ability of the CPET to predict postoperative complications.\u003c/p\u003e \u003cp\u003eIn our study, patients with severe complications demonstrated a trend toward a lower level of preoperative physical activity. A small study found a lower level of physical activity to be an independent risk factor for developing postoperative complications after esophagectomy for esophageal cancer(\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The idea that greater physical activity before surgery would lead to fewer postoperative complications seems intuitively reasonable, possibly through a greater reserve capacity. Several studies have shown the potential of prehabilitation in preventing pulmonary complications after surgery(\u003cspan additionalcitationids=\"CR41\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), which has led to larger intervention studies on the subject, such as the PREPARE study(\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e). Starting rehabilitation with a higher level of overall fitness should likely improve the end results.\u003c/p\u003e \u003cp\u003eWe could not show any association between sarcopenia prior to surgery and the incidence of severe complications postoperatively. Similar results have been described in earlier studies(\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), but a larger number of studies have shown positive results, linking sarcopenia to morbidity and mortality after major surgery(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The awareness of sarcopenia and the number of tools to diagnose it have increased in recent years. Grip strength measurements and the TUG test have shown potential in diagnosing sarcopenia and are also recommended in the most recent guidelines(\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). In our study, we were also unable to confirm any association between these tests and sarcopenia. However, this study was not designed to establish such an association; the reference values linked to grip strength and TUG listed in the guidelines differ from the test results in this study, which might indicate a difficulty in using the proposed reference values on a group already selected for surgery.\u003c/p\u003e \u003cp\u003eStrengths and limitations\u003c/p\u003e \u003cp\u003eThis is a multi-center study with reliable data, either gathered by the authors or obtained from a validated register(\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). The included patients constitute a population-based cohort for Sweden\u0026rsquo;s three largest university hospitals\u0026rsquo; catchment areas, corroborated by the fact that demographic data are similar to data reported in NREV(\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). All tests included in the analyses are standardized, validated and reliable, making the methods easy to replicate in future studies. Every center assigned the same detailed manual to each test, which makes the results comparable between centers. Furthermore, reference values, adjusted for sex and age, were used for 6MWT, MIP, MEP and grip strength, TUG, timed-stands and FVC, FEV1 and PEF, making comparisons between groups more representable.\u003c/p\u003e \u003cp\u003eAll tests used in this study are easy to perform and require almost no extra equipment for the physiotherapist, making them easy to introduce into clinical practice.\u003c/p\u003e \u003cp\u003eMany of the tests were performed not more than 10 days prior to surgery. Except for CPET and spirometry, no additional testing was performed before neoadjuvant oncological therapy. The neoadjuvant therapy often leads to deteriorating physical fitness. If the same tests were performed before the neoadjuvant treatment started, it would be possible to compare the test results and identify the patients with the greatest decline, using patients as their own references, which could be of clinical importance. Similarly, the CT scans used to identify sarcopenia in this study were all performed prior to neoadjuvant therapy. Elliot et al demonstrated a 15% increase in sarcopenia during neoadjuvant oncological therapy, indicating that sarcopenia may be more prevalent among patients undergoing surgery than has been previously understood(\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDue to the overall lack of earlier studies on the predictive capabilities of phyiscal tests for postoperative complications after esophagectomy, this study was designed as an explorative, hypothesis-generating study. We therefore chose to include several different tests in the study design, in search of results promising enough to motivate further studies on this subject. Esophagectomy is a rather uncommon procedure, yielding small cohorts overall, and even though we have included patients from the three largest catchment areas in Sweden, the study still risks being underpowered overall, and does not allow for adjusting for confounders in multivariable analyses.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis small, explorative, hypothesis-generating study has shown a potential benefit of using some cheap and easily replicable physical tests to determine the overall risk of curative surgery for esophageal cancer. With a greater understanding of the individual patient\u0026rsquo;s physical preoperative condition, we may be able to identify patients with a higher risk of a complicated course postoperatively, and hopefully better select, inform, and optimize patients before they undergo surgery that, while designed to cure them, might instead harm them.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for collecting data were acquired from Regionala Etikpr\u0026ouml;vningsn\u0026auml;mnden (EPN). Number of approval: 1028-13. All patients in the study did consent to participate in this study and left a written and informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available due to patient secrecy but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWork was supported by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF agreement (ALFGBG-718811).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNorr RC. Matstrups- och ventrikelcancer. Nationellt v\u0026aring;rdprogram 2019 [Available from: https://cancercentrum.se/samverkan/cancerdiagnoser/matstrupe-och-magsack/vardprogram/.\u003c/li\u003e\n\u003cli\u003eGoense L, van Dijk WA, Govaert JA, van Rossum PS, Ruurda JP, van Hillegersberg R. Hospital costs of complications after esophagectomy for cancer. Eur J Surg Oncol. 2016.\u003c/li\u003e\n\u003cli\u003eJiang H, Hua R, Sun Y, Guo X, Liu Z, Su Y, et al. Risk Factors for Anastomotic Complications After Radical McKeown Esophagectomy. Ann Thorac Surg. 2021;112(3):944-51.\u003c/li\u003e\n\u003cli\u003eAoyama T, Atsumi Y, Hara K, Tamagawa H, Tamagawa A, Komori K, et al. Risk Factors for Postoperative Anastomosis Leak After Esophagectomy for Esophageal Cancer. In Vivo. 2020;34(2):857-62.\u003c/li\u003e\n\u003cli\u003eSteyerberg EW, Neville B, Weeks JC, Earle CC. Referral Patterns, Treatment Choices, and Outcomes in Locoregional Esophageal Cancer: A Population-Based Analysis of Elderly Patients. Journal of Clinical Oncology. 2007;25(17):2389-96.\u003c/li\u003e\n\u003cli\u003eHagens ERC, Reijntjes MA, Anderegg MCJ, Eshuis WJ, Van Berge Henegouwen MI, Gisbertz SS. Risk Factors and Consequences of Anastomotic Leakage After Esophagectomy for Cancer. The Annals of Thoracic Surgery. 2021;112(1):255-63.\u003c/li\u003e\n\u003cli\u003eOhi M, Toiyama Y, Omura Y, Ichikawa T, Yasuda H, Okugawa Y, et al. Risk factors and measures of pulmonary complications after thoracoscopic esophagectomy for esophageal cancer. Surgery Today. 2019;49(2):176-86.\u003c/li\u003e\n\u003cli\u003eKassis ES, Kosinski AS, Ross P, Koppes KE, Donahue JM, Daniel VC. Predictors of Anastomotic Leak After Esophagectomy: An Analysis of The Society of Thoracic Surgeons General Thoracic Database. The Annals of Thoracic Surgery. 2013;96(6):1919-26.\u003c/li\u003e\n\u003cli\u003eBoutin RD, Yao L, Canter RJ, Lenchik L. Sarcopenia: Current Concepts and Imaging Implications. AJR Am J Roentgenol. 2015;205(3):W255-66.\u003c/li\u003e\n\u003cli\u003eDeng HY, Zha P, Peng L, Hou L, Huang KL, Li XY. Preoperative sarcopenia is a predictor of poor prognosis of esophageal cancer after esophagectomy: a comprehensive systematic review and meta-analysis. Dis Esophagus. 2018.\u003c/li\u003e\n\u003cli\u003eKoch C, Reitz C, Schreckenbach T, Eichler K, Filmann N, Al-Batran S-E, et al. Sarcopenia as a prognostic factor for survival in patients with locally advanced gastroesophageal adenocarcinoma. PLOS ONE. 2019;14(10):e0223613.\u003c/li\u003e\n\u003cli\u003eInoue T, Ito S, Ando M, Nagaya M, Aso H, Mizuno Y, et al. Changes in exercise capacity, muscle strength, and health-related quality of life in esophageal cancer patients undergoing esophagectomy. BMC Sports Sci Med Rehabil. 2016;8:34.\u003c/li\u003e\n\u003cli\u003eKeeratichananont W, Thanadetsuntorn C, Keeratichananont S. Value of preoperative 6-minute walk test for predicting postoperative pulmonary complications. Therapeutic advances in respiratory disease. 2016;10(1):18-25.\u003c/li\u003e\n\u003cli\u003eWhibley J, Peters CJ, Halliday LJ, Chaudry AM, Allum WH. Poor performance in incremental shuttle walk and cardiopulmonary exercise testing predicts poor overall survival for patients undergoing esophago-gastric resection. Eur J Surg Oncol. 2018;44(5):594-9.\u003c/li\u003e\n\u003cli\u003eBolger JC, Loughney L, Tully R, Cunningham M, Keogh S, McCaffrey N, et al. Perioperative prehabilitation and rehabilitation in esophagogastric malignancies: a systematic review. Diseases of the Esophagus. 2019;32(9).\u003c/li\u003e\n\u003cli\u003eFeeney C, Reynolds JV, Hussey J. Preoperative physical activity levels and postoperative pulmonary complications post-esophagectomy. Dis Esophagus. 2011;24(7):489-94.\u003c/li\u003e\n\u003cli\u003eDoganay E, Moorthy K. Prehabilitation for esophagectomy. Journal of Thoracic Disease. 2019;11(S5):S632-S8.\u003c/li\u003e\n\u003cli\u003eLevett DZH, Jack S, Swart M, Carlisle J, Wilson J, Snowden C, et al. Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation. Br J Anaesth. 2018;120(3):484-500.\u003c/li\u003e\n\u003cli\u003eQuanjer PH, Tammeling GJ, Cotes JE, Pedersen OF, Peslin R, Yernault JC. Lung volumes and forced ventilatory flows. Eur Respir J. 1993;6 Suppl 16:5-40.\u003c/li\u003e\n\u003cli\u003eLiou TG, Kanner RE. Spirometry. Clin Rev Allergy Immunol. 2009;37(3):137-52.\u003c/li\u003e\n\u003cli\u003eXu J-Y, Li C, Zhang H, Liu Y, Wei J-M. \u0026lt;p\u0026gt;Total Psoas Area Index is Valuable to Assess Sarcopenia, Sarcopenic Overweight/Obesity and Predict Outcomes in Patients Undergoing Open Pancreatoduodenectomy\u0026lt;/p\u0026gt;. Risk Management and Healthcare Policy. 2020;Volume 13:761-70.\u003c/li\u003e\n\u003cli\u003eRangel EL, Rios-Diaz AJ, Uyeda JW, Castillo-Angeles M, Cooper Z, Olufajo OA, et al. Sarcopenia increases risk of long-term mortality in elderly patients undergoing emergency abdominal surgery. J Trauma Acute Care Surg. 2017;83(6):1179-86.\u003c/li\u003e\n\u003cli\u003eSmyth RJ, Chapman KR, Rebuck AS. Maximal Inspiratory and Expiratory Pressures in Adolescents. None. 1984;86(4).\u003c/li\u003e\n\u003cli\u003eBackman E, Johansson V, Hager B, Sjoblom P, Henriksson KG. Isometric muscle strength and muscular endurance in normal persons aged between 17 and 70 years. Scand J Rehabil Med. 1995;27(2):109-17.\u003c/li\u003e\n\u003cli\u003eCider \u0026Aring;, Carlsson S, Arvidsson C, Andersson B, Stibrant Sunnerhagen K. Reliability of Clinical Muscular Endurance Tests in Patients with Chronic Heart Failure. European Journal of Cardiovascular Nursing. 2006;5(2):122-6.\u003c/li\u003e\n\u003cli\u003ePodsiadlo D, Richardson S. The Timed \u0026ldquo;Up \u0026amp; Go\u0026rdquo;: A Test of Basic Functional Mobility for Frail Elderly Persons1991. 142-8 p.\u003c/li\u003e\n\u003cli\u003eCsuka M, McCarty DJ. Simple method for measurement of lower extremity muscle strength. The American Journal of Medicine. 1985;78(1).\u003c/li\u003e\n\u003cli\u003eRae Lunsford B, Perry J. The Standing Heel-Rise Test for Ankle Plantar Flexion: Criterion for Normal1995. 694-8 p.\u003c/li\u003e\n\u003cli\u003eCraig CL, Marshall AL, Sjostrom M, Bauman AE, Booth ML, Ainsworth BE, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35(8):1381-95.\u003c/li\u003e\n\u003cli\u003eIPAQ. Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ). 2005.\u003c/li\u003e\n\u003cli\u003eLinder G, Lindblad M, Djerf P, Elbe P, Johansson J, Lundell L, et al. Validation of data quality in the Swedish National Register for Oesophageal and Gastric Cancer. Br J Surg. 2016;103(10):1326-35.\u003c/li\u003e\n\u003cli\u003eLai Y, Wang X, Li P, Li J, Zhou K, Che G. Preoperative peak expiratory flow (PEF) for predicting postoperative pulmonary complications after lung cancer lobectomy: a prospective study with 725 cases. Journal of Thoracic Disease. 2018;10(7):4293-301.\u003c/li\u003e\n\u003cli\u003eZhou K, Wu Y, Su J, Lai Y, Shen C, Li P, et al. [Can Preoperative Peak Expiratory Flow Predict Postoperative Pulmonary Complications in Lung Cancer Patients Undergoing Lobectomy?]. Zhongguo Fei Ai Za Zhi. 2017;20(9):603-9.\u003c/li\u003e\n\u003cli\u003eLiedman BL, Benneg\u0026aring;rd K, Olbe LC, Lundell LR. Predictors of postoperative morbidity and mortality after surgery for gastro-oesophageal carcinomas. Eur J Surg. 1995;161(3):173-80.\u003c/li\u003e\n\u003cli\u003ePatel N, Powell AG, Wheat JR, Brown C, Appadurai IR, Davies RG, et al. Cardiopulmonary fitness predicts postoperative major morbidity after esophagectomy for patients with cancer. Physiological Reports. 2019;7(14).\u003c/li\u003e\n\u003cli\u003eNagamatsu Y, Shima I, Yamana H, Fujita H, Shirouzu K, Ishitake T. Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus. J Thorac Cardiovasc Surg. 2001;121(6):1064-8.\u003c/li\u003e\n\u003cli\u003eMoyes LH, McCaffer CJ, Carter RC, Fullarton GM, Mackay CK, Forshaw MJ. Cardiopulmonary exercise testing as a predictor of complications in oesophagogastric cancer surgery. Ann R Coll Surg Engl. 2013;95(2):125-30.\u003c/li\u003e\n\u003cli\u003eLam S, Alexandre L, Hardwick G, Hart AR. The association between preoperative cardiopulmonary exercise\u0026amp;#x2013;test variables and short-term morbidity after esophagectomy: A\u0026amp;#xa0;hospital-based cohort study. Surgery. 2019;166(1):28-33.\u003c/li\u003e\n\u003cli\u003eNoriatsu Tatematsu1* MP, Eiji Tanaka2, Yoshiharu Sakai2, Tadao Tsuboyama1. Association between Physical Activity and Postoperative Complications after Esophagectomy for Cancer: A Prospective Observational Study. 2013.\u003c/li\u003e\n\u003cli\u003eSoares SM, Nucci LB, da Silva MM, Campacci TC. Pulmonary function and physical performance outcomes with preoperative physical therapy in upper abdominal surgery: a randomized controlled trial. Clin Rehabil. 2013;27(7):616-27.\u003c/li\u003e\n\u003cli\u003eHulzebos EHJ, Helders PJM, Favi\u0026eacute; NJ, De Bie RA, Brutel De La Riviere A, Van Meeteren NLU. Preoperative Intensive Inspiratory Muscle Training to Prevent Postoperative Pulmonary Complications in High-Risk Patients Undergoing CABG Surgery. JAMA. 2006;296(15):1851.\u003c/li\u003e\n\u003cli\u003eKendall F, Oliveira J, Peleteiro B, Pinho P, Bastos PT. Inspiratory muscle training is effective to reduce postoperative pulmonary complications and length of hospital stay: a systematic review and meta-analysis. Disability and Rehabilitation. 2018;40(8):864-82.\u003c/li\u003e\n\u003cli\u003eValkenet K, Trappenburg JC, Gosselink R, Sosef MN, Willms J, Rosman C, et al. Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): study protocol for a randomized controlled trial. Trials. 2014;15(1):144.\u003c/li\u003e\n\u003cli\u003eGrotenhuis BA, Shapiro J, van Adrichem S, de Vries M, Koek M, Wijnhoven BP, et al. Sarcopenia/Muscle Mass is not a Prognostic Factor for Short- and Long-Term Outcome After Esophagectomy for Cancer. World J Surg. 2016;40(11):2698-704.\u003c/li\u003e\n\u003cli\u003eCruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyere O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31.\u003c/li\u003e\n\u003cli\u003eCruz-Jentoft AJ, Sayer AA. Sarcopenia. The Lancet. 2019;393(10191):2636-46.\u003c/li\u003e\n\u003cli\u003eGoense L, van Rossum PS, Tromp M, Joore HC, van Dijk D, Kroese AC, et al. Intraoperative and postoperative risk factors for anastomotic leakage and pneumonia after esophagectomy for cancer. Dis Esophagus. 2016.\u003c/li\u003e\n\u003cli\u003eNord R. NREV \u0026aring;rsrapport. 2020.\u003c/li\u003e\n\u003cli\u003eElliott JA, Doyle SL, Murphy CF, King S, Guinan EM, Beddy P, et al. Sarcopenia: Prevalence, and Impact on Operative and Oncologic Outcomes in the Multimodal Management of Locally Advanced Esophageal Cancer. Ann Surg. 2017;266(5):822-30.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"oesophagectomy, complication, peak expiratory flow, shoulder abduction","lastPublishedDoi":"10.21203/rs.3.rs-3866057/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3866057/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eComplications after esophagectomy result in higher morbidity and mortality, longer hospital stays and lower quality of life. Unfortunately, we have insufficient knowledge of which patients will tolerate the combination of strenuous oncological therapy and major surgery. This study was designed to evaluate whether additional physical tests, apart from standard preoperative workups, could help identify high-risk patients regarding esophageal cancer surgery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA total of 88 patients due to undergo esophagectomy for esophageal cancer were enrolled. In addition to the mandatory physical examinations, seven additional physical therapy tests were carried out within 10 days prior to surgery. CT scans were examined by an experienced radiologist to determine whether patients suffered from sarcopenia. Perioperative data and times of death were gathered from a national register. The primary outcome was the presence of any severe postoperative complication, classified as Clavien-Dindo \u0026ge;3, with specific complications as secondary outcomes, and associations between preoperative test performance and complications were examined.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003ePatients with severe complications had preoperatively performed significantly worse on peak expiratory flow tests (p\u0026thinsp;=\u0026thinsp;0.013). Patients suffering from anastomotic leakage had shown significantly worse performance on cardiopulmonary exercise testing, whereas the results from shoulder abduction tests were significantly lower in patients who later suffered from pneumonia (p\u0026thinsp;=\u0026thinsp;0.034 and p\u0026thinsp;=\u0026thinsp;0.043, respectively).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMore extensive preoperative physical examination tests could potentially aid in identifying patients with an increased risk of postoperative complications. Further studies are needed on the subject to corroborate these findings and evaluate their clinical use.\u003c/p\u003e","manuscriptTitle":"Prediction of morbidity and mortality after thoracoabdominal esophageal surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-29 09:39:48","doi":"10.21203/rs.3.rs-3866057/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3cdfb5c0-d607-4656-a104-c1dee2823542","owner":[],"postedDate":"January 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-21T11:29:57+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-29 09:39:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3866057","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3866057","identity":"rs-3866057","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}