The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery

Jack, Sandy; West, Malcolm; Raw, David; Marwood, Simon; Ambler, Gareth; Cope, TM; Shrotri, M; Sturgess, Richard; Calverley, Peter M.A.; Ottensmeier, Christian; Grocott, Michael P.W.

doi:10.1016/j.ejso.2014.03.010

Cited by 141 publications

(111 citation statements)

References 21 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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“…In a preliminary study, we showed, in a small number of patients, that neoadjuvant chemotherapy (NAC) before upper gastrointestinal (UGI) cancer surgery significantly reduced physical fitness [7]. In this study, lower baseline fitness was associated with reduced 1-year-survival in patients completing NAC and surgery, but not in patients who did not complete NAC.…”

Section: Introductionmentioning

confidence: 84%

“…Oesophageal and gastric neoadjuvant cancer treatments together with surgery have been associated with 1-year mortality [7]. The reliability and association of CPET variables with outcome following major surgery has now been established [13–15].…”

Section: Discussionmentioning

confidence: 99%

The effect of neoadjuvant chemotherapy and chemoradiotherapy on exercise capacity and outcome following upper gastrointestinal cancer surgery: an observational cohort study

et al. 2016

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Background: In 2014 approximately 21,200 patients were diagnosed with oesophageal and gastric cancer in England and Wales, of whom 37 % underwent planned curative treatments. Potentially curative surgical resection is associated with significant morbidity and mortality. For operable locally advanced disease, neoadjuvant chemotherapy (NAC) improves survival over surgery alone. However, NAC carries the risk of toxicity and is associated with a decrease in physical fitness, which may in turn influence subsequent clinical outcome. Lower levels of physical fitness are associated with worse outcome following major surgery in general and Upper Gastrointestinal Surgery (UGI) surgery in particular. Cardiopulmonary exercise testing (CPET) provides an objective assessment of physical fitness. The aim of this study is to test the hypothesis that NAC prior to upper gastrointestinal cancer surgery is associated with a decrease in physical fitness and that the magnitude of the change in physical fitness will predict mortality 1 year following surgery.

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“…A UK study demonstrated a significant decrement in CPET-derived anaerobic threshold and peak oxygen consumption in neoadjuvant chemotherapy (NAC) patients before elective upper gastrointestinal surgery [51**]. Lower baseline fitness associated with reduced one-year-survival in patients completing NAC and surgery, but not in patients who did not complete NAC.…”

Section: Personalizing Prehabilitative and Post-icu Exercise Intervenmentioning

confidence: 99%

Muscle mass and physical recovery in ICU: innovations for targeting of nutrition and exercise

Wischmeyer

Puthucheary

Millán

et al. 2017

Current Opinion in Critical Care

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Purpose of Review We have significantly improved hospital mortality from sepsis and critical illness in last 10 years, however over this same period we have tripled the number of “ICU survivors” going to rehabilitation. Further, as up to half the deaths in the first year following ICU admission occur post-ICU discharge, it is unclear how many of these patients ever returned home or a meaningful quality of life (QoL). For those who do survive, recent data reveals many “ICU survivors” will suffer significant functional impairment or Post-ICU Syndrome (PICS). Thus, new innovative metabolic and exercise interventions to address PICS are urgently needed. These should focus on optimal nutrition and lean body mass (LBM) assessment, targeted nutrition delivery, anabolic/anti-catabolic strategies, and utilization of personalized exercise intervention techniques, such as utilized by elite athletes to optimize preparation and recovery from critical care. Recent findings New data for novel LBM analysis technique such as CT scan and ultrasound analysis of lean body mass are available showing objective measures of LBM now becoming more practical for predicting metabolic reserve and effectiveness of nutrition/exercise interventions. 13C-breath testing is a novel technique under study to predict infection earlier and predict over- and under-feeding to target nutrition delivery. New technologies utilized routinely by athletes such as muscle glycogen ultrasound also show promise. Finally, the role of personalized cardiopulmonary exercise testing (CPET) to target pre-operative exercise optimization and post-ICU recovery are becoming reality. Summary New innovative techniques are demonstrating promise to target recovery from PICS utilizing a combination of objective LBM and metabolic assessment, targeted nutrition interventions, personalized exercise interventions for prehabilitation and post-ICU recovery. These interventions should provide hope that we will soon begin to create more “survivors” and fewer victim's post-ICU care.

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The effect of neoadjuvant chemotherapy on physical fitness and survival in patients undergoing oesophagogastric cancer surgery

Cited by 141 publications

References 21 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

The effect of neoadjuvant chemotherapy and chemoradiotherapy on exercise capacity and outcome following upper gastrointestinal cancer surgery: an observational cohort study

Muscle mass and physical recovery in ICU: innovations for targeting of nutrition and exercise

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