Improved Disease-free Survival After Prehabilitation for Colorectal Cancer Surgery

Trépanier, Maude; Minnella, Enrico Maria; Paradis, Tiffany; Awasthi, Rashami; Kaneva, Pepa; Schwartzman, Kevin; Carli, Franco; Fried, Gerald M.; Feldman, Liane S.; Lee, Lawrence

doi:10.1097/sla.0000000000003465

Cited by 147 publications

(72 citation statements)

References 52 publications

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“…Recent research show that patients presenting for surgery for colorectal cancer can signi cantly engage with and bene t from preoperative exercise even for short intervals 15,16 . Improved postoperative outcomes have been demonstrated in some studies, pointing to a possible shared mechanism or marker of in ammatory mediators.…”

Section: Resultsmentioning

confidence: 99%

Preoperative C-Reactive Protein as A Predictor of Postoperative Complications in Patients Undergoing Surgery for Colorectal Neoplasia

Alsaif

Rogers

Pua

et al. 2020

Preprint

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Background: Inflammatory markers are measured following colorectal surgery to detect postoperative complications. However, the association of these markers preoperatively with subsequent postoperative course has not yet been usefully studied. Aim: The aim of this study is to assess the ability of preoperative C-reactive protein (CRP) and other inflammatory marker measurements in the prediction of postoperative morbidity after elective colorectal surgery. Methods: This retrospective study catalogues 218 patients undergoing elective, potentially-curative surgery for colorectal neoplasia. Preoperative laboratory results of the full blood count (FBC), C-reactive protein (CRP) and carcinoembryonic antigen (CEA) were recorded. Multivariable analysis was performed to examine preoperative variables against 30-day postoperative complications by type and grade (Clavien-Dindo (CD)), adjusting for age, sex, BMI, smoking status, medical history, open versus laparoscopic operation, and tumor characteristics. Results: Elevated preoperative CRP (≥ 5 mg/L) was significantly predictive of all-cause mortality, with an OR of 17.0 (p < 0.001) and was the strongest factor to predict a CD morbidity grade ≥ 3 (OR 41.9, p < 0.001). Other factors predictive of CD morbidity grade ≥ 3 included smoking, elevated preoperative platelet count and elevated preoperative neutrophil-lymphocyte ratio (OR 15.6, 8.6 and 6.3 respectively, all p < 0.05). CRP values above 5.5 mg/L were indicative of all-cause morbidity (AUC=0.871), and values above 17.5 mg/L predicted severe complications (AUC=0.934). Conclusions: Elevated preoperative CRP predicts increased postoperative morbidity in this patient cohort. The results herein aid risk and resource stratification and encourage preoperative assessment of inflammatory propensity besides simple sepsis exclusion.

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Section: Resultsmentioning

confidence: 99%

Preoperative C-Reactive Protein as A Predictor of Postoperative Complications in Patients Undergoing Surgery for Colorectal Neoplasia

Alsaif

Rogers

Pua

et al. 2020

Preprint

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“…Since many disciplines are involved and time is limited, multimodal prehabilitation is a logistic challenge for any hospital. It is widely studied in patients with colorectal cancer and deemed feasible and effective (14,36,37). However, the treatment interval for NSCLC is shorter than for colorectal cancer in the Netherlands due to tumour biology.…”

Section: Discussionmentioning

confidence: 99%

Multimodal Prehabilitation in Patients with Non-Small Cell Lung Cancer Undergoing Anatomical Resection: Protocol of a Non-Randomised Feasibility Study

Molenaar

Meyenfeldt

Betue

et al. 2020

Preprint

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BackgroundThe preoperative period can be used to enhance a patient’s functional capacity with multimodal prehabilitation and, consequently improve and fasten postoperative recovery. Especially non-small cell lung cancer (NSCLC) surgical patients may benefit from this intervention, since the affected and resected organ is an essential part of the cardiorespiratory fitness. Drafting a prehabilitation programme is a challenge, since many disciplines are involved, and time between diagnosis of NSCLC and surgery is limited. We designed a multimodal prehabilitation programme prior to pulmonary surgery and conduct a study to assess feasibility and efficacy of the programme. Publication of this protocol may help other health care facilities to implement such a programme. MethodsThe multimodal prehabilitation programme consists of an exercise programme, nutritional support, mental support, smoking cessation programme, patient empowerment and respiratory optimisation. In two Dutch teaching hospitals, 40 adult patients with proven or suspected NSCLC will be included. In a non-randomised fashion, 20 patients follow the multimodal prehabilitation programme and 20 will be assessed in the control group, according to patient preference. Assessments take place at four time points: baseline, week before surgery, six weeks postoperatively and three months postoperatively. Feasibility and efficacy of the prehabilitation programme will be assessed as primary outcomes. DiscussionSince the time between diagnosis of NSCLC and surgery is limited, it is a challenge to implement a prehabilitation programme. This study will assess whether this is feasible and effective. The non-randomised fashion of the study might result in a selection bias. However, the control group is necessary, to put the prehabilitation group in perspective and to assess feasibility further. By publishing this protocol of our feasibility study, we aim to facilitate others to evaluate and implement a multimodal prehabilitation programme for surgical lung cancer patients.Trial registrationThis feasibility study is registered as NL8080 in the Netherlands Trial Register on the 10th of October 2019, https://www.trialregister.nl/trial/8080. Secondary identifiers: CCMO (Central Committee on Research Involving Human Subjects) number NL70578.015.19, reference number of the Medical Ethical Review Committee of Máxima MC W19.045.

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“…Should we advocate for initiating cardio-oncology prehabilitation before patients undergo chemotherapy, radiation, or surgery? In the overall surgical world, exercise or nutritional prehabilitation (initiated before surgery) seems to improve outcomes and lower healthcare costs compared to waiting for rehabilitation (initiated after surgery) alone (124)(125)(126)(127)(128)(129)(130)(131)(132)(133)(134)(135)(136)(137). Clinical trials are underway to further define the prehabilitation period (before surgical therapy) as optimal for fitness intervention (138)(139)(140).…”

Section: Rehabilitation Too Late?mentioning

confidence: 99%

Preventive Cardio-Oncology: The Time Has Come

Brown

2020

Front. Cardiovasc. Med.

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Improved Disease-free Survival After Prehabilitation for Colorectal Cancer Surgery

Cited by 147 publications

References 52 publications

Preoperative C-Reactive Protein as A Predictor of Postoperative Complications in Patients Undergoing Surgery for Colorectal Neoplasia

Preoperative C-Reactive Protein as A Predictor of Postoperative Complications in Patients Undergoing Surgery for Colorectal Neoplasia

Multimodal Prehabilitation in Patients with Non-Small Cell Lung Cancer Undergoing Anatomical Resection: Protocol of a Non-Randomised Feasibility Study

Preventive Cardio-Oncology: The Time Has Come

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