Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery

West, Malcolm; Parry, Matthew G.; Lythgoe, Daniel; Barben, Christopher; Kemp, Graham J.; Grocott, Michael P.W.; Jack, Sandy

doi:10.1002/bjs.9551

Cited by 105 publications

(83 citation statements)

References 24 publications

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“…The ability of CPET to identify patients at risk of poor outcomes is used clinically to guide perioperative care and clinical decision making, and it informs about the shared decision‐making process . We have previously reported that selected CPET variables such as oxygen uptake at estimated lactate threshold or anaerobic threshold (

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O 2 at AT) and at peak exercise (

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O 2 peak) are associated with worse outcome following colorectal surgery and neoadjuvant cancer treatments . Poor physical fitness is highly prevalent in HPB cancer patients and associated with poor post‐operative outcomes and survival …”

Section: Introductionmentioning

confidence: 99%

Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

West

Dijk

Gleadowe

et al. 2019

J cachexia sarcopenia muscle

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Background Body composition assessment, measured using single‐slice computed tomography (CT) image at L3 level, and aerobic physical fitness, objectively measured using cardiopulmonary exercise testing (CPET), are each independently used for perioperative risk assessment. Sarcopenia (i.e. low skeletal muscle mass), myosteatosis [i.e. low skeletal muscle radiation attenuation (SM‐RA)], and impaired objectively measured aerobic fitness (reduced oxygen uptake) have been associated with poor post‐operative outcomes and survival in various cancer types. However, the association between CT body composition and physical fitness has not been explored. In this study, we assessed the association of CT body composition with selected CPET variables in patients undergoing hepatobiliary and pancreatic surgery. Methods A pragmatic prospective cohort of 123 patients undergoing hepatobiliary and pancreatic surgery were recruited. All patients underwent preoperative CPET. Preoperative CT scans were analysed using a single‐slice CT image at L3 level to assess skeletal muscle mass, adipose tissue mass, and muscle radiation attenuation. Multivariate linear regression was used to test the association between CPET variables and body composition. Main outcomes were oxygen uptake at anaerobic threshold ( O 2 at AT), oxygen uptake at peak exercise ( O 2 peak), skeletal muscle mass, and SM‐RA. Results Of 123 patients recruited [77 men (63%), median age 66.9 ± 11.7, median body mass index 27.3 ± 5.2], 113 patients had good‐quality abdominal CT scans available and were included. Of the CT body composition variables, SM‐RA had the strongest correlation with O 2 peak ( r = 0.57, P < 0.001) and O 2 at AT ( r = 0.45, P < 0.001) while skeletal muscle mass was only weakly associated with O 2 peak ( r = 0.24, P < 0.010). In the multivariate analysis, only SM‐RA was associated with O 2 peak ( B = 0.25, 95% CI 0.15–0.34, P < 0.001, R 2 = 0.42) and O 2 at AT ( B = 0.13, 95% CI 0.06–0.18, P < 0.001, R 2 = 0.26). Conclusions There is a positive association between preoperative CT SM‐RA and preoperative physical fitness ( O 2 at AT and at peak). This study demonstrates that myosteatosis, and not sarcopenia, is associated with reduced aerobic physical fitness. Com...

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O 2 at AT) and at peak exercise (

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Section: Introductionmentioning

confidence: 99%

Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

West

Dijk

Gleadowe

et al. 2019

J cachexia sarcopenia muscle

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“…morbidity, mortality, length of stay) [1][2][3][4][5][6][7][8][9][10][11][12]. Similar to immunological and neuroendocrine reserve, cardiorespiratory fitness indicates the physiological reserve capacity of the patient to maintain homeostasis with adequate responses to allostatic load (allostasis).…”

Section: Introductionmentioning

confidence: 99%

An evaluation of the validity of the pre‐operative oxygen uptake efficiency slope as an indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery

et al. 2017

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This study aimed to investigate the validity of the oxygen uptake efficiency slope as an objective and submaximal indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery. Patients ≥ 60 years of age, with a metabolic equivalent score using the Veterans Activity Questionnaire ≤ 7 and scheduled for major colorectal surgery participated in a pre-operative cardiopulmonary exercise test. The oxygen uptake efficiency slope was calculated up to different exercise intensities, using 100%, 90% and 80% of the exercise data. Data from 71 patients (47 men, mean (SD) age 75.2 (6.7) years) were analysed. The efficiency slope obtained from all the data was statistically significantly different from the values when 90% (p = 0.027) and 80% (p = 0.023) of the data were used. The 90% and 80% values did not differ significantly from each other (p = 0.152). Correlations between the oxygen uptake efficiency slope and the peak oxygen uptake ranged from 0.816 to 0.825 (all p < 0.001), and correlations between oxygen uptake efficiency slope and the ventilatory anaerobic threshold ranged from 0.793 to 0.805 (all p < 0.001). Receiver operating characteristic curves showed that the oxygen uptake efficiency slope is a sensitive and specific predictor of a peak oxygen uptake ≤ 18.2 ml.kg .min , with an area under the curve (95%CI) of 0.876 (0.780-0.972, p < 0.001) and a ventilatory anaerobic threshold ≤ 11.1 ml.kg .min , with an area under the curve (95%CI) of 0.828 (0.726-0.929, p < 0.001). These correlations suggest that the oxygen uptake efficiency slope provides a valid (sub)maximal measure of cardiorespiratory fitness in these patients, and the predictive ability described indicates that it might help discriminate patients at higher risk of postoperative morbidity. However, future research should investigate the prognostic value of the oxygen uptake efficiency slope for postoperative outcomes.

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“…The time pressure experienced in the UK and internationally may well contribute to the lack of quality research and subsequent evidence base supporting the use of exercise treatments in the period between decision to treat and surgery for colorectal cancer. Given however, that recent work has shown that those with improved cardio-respiratory fitness have lower rates of mortality and complications following colorectal cancer surgery [8,9], this time period provides an opportunity to attempt to improve cardio-respiratory fitness before surgery, with the possibility of reducing peri-operative risk and improving post-operative outcome.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of pre-operative exercise in colorectal cancer patients

et al. 2015

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A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. AcknowledgementsThe authors declare that they have no conflicts of interest. We would like to acknowledge the help of Suzanne Toft, the clinical librarian who conducted the electronic search strategy.2 Abstract PurposeThe aim of this systematic review was to evaluate the evidence for exercise interventions prior to surgery for colorectal cancer resection. The evidence for use of exercise to improve physical fitness and surgical outcomes is as yet unknown. MethodA systematic search was performed of MEDLINE, EMBASE, CINAHL, AMED and BNI databases for studies involving pre-operative exercise in colorectal cancer patients. ResultsEight studies were included in the review. There is evidence that pre-operative exercise improves functional fitness, and to a lesser extent objectively measurable cardio-respiratory fitness prior to colorectal cancer resection. There is no clear evidence at present that this improvement in fitness translates into reduced peri-operative risk or improved post-operative outcomes. Current studies are limited by risk of bias. ConclusionsThis review highlights the common difficulty in transferring promising results in a research setting, into significant improvements in the clinical arena. Future research should focus on which type of exercise is most likely to maximise patient adherence and improvements in cardio-respiratory fitness.Ultimately, adequately powered, randomised controlled trials are needed to investigate if pre-operative exercise improves post-operative morbidity and mortality.

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Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery

Abstract: CPET can help predict morbidity after rectal cancer surgery.

Cited by 105 publications

References 24 publications

Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

Myosteatosis is associated with poor physical fitness in patients undergoing hepatopancreatobiliary surgery

An evaluation of the validity of the pre‐operative oxygen uptake efficiency slope as an indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery

Systematic review of pre-operative exercise in colorectal cancer patients

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