The effect of pre- and post-operative physical activity on recovery after colorectal cancer surgery (PHYSSURG-C): study protocol for a randomised controlled trial

Abstract

BackgroundSurgery for colorectal cancer is associated with a high risk of post-operative adverse events, re-operations and a prolonged post-operative recovery. Previously, the effect of prehabilitation (pre-operative physical activity) has been studied for different types of surgery, including colorectal surgery. However, the trials on colorectal surgery have been of limited methodological quality and size. The aim of this trial is to compare the effect of a combined pre- and post-operative intervention of moderate aerobic physical activity and inspiratory muscle training (IMT) with standard care on post-operative recovery after surgery for colorectal cancer.Methods/designWe are conducting a randomised, controlled, parallel-group, open-label, multi-centre trial with physical recovery within 4 weeks after cancer surgery as the primary endpoint. Some 640 patients planned for surgery for colorectal cancer will be enrolled. The intervention consists of pre- and post-operative physical activity with increased daily aerobic activity of moderate intensity as well as IMT. In the control group, patients will be advised to continue their normal daily exercise routine. The primary outcome is patient-reported physical recovery 4 weeks post-operatively. Secondary outcomes are length of sick leave, complication rate and severity, length of hospital stay, re-admittances, re-operations, post-operative mental recovery, quality of life and mortality, as well as changes in insulin-like growth factor 1 and insulin-like growth factor-binding protein 3, perception of pain and a health economic analysis.DiscussionAn increase in moderate-intensity aerobic physical activity is a safe, cheap and feasible intervention that would be possible to implement in standard care for patients with colorectal cancer. If shown to be effective, this lifestyle intervention could be a clinical parallel to pre-operative smoke cessation that has already been implemented with good clinical results.Trial registrationClinicalTrials.gov identifier: NCT02299596. Registered on 17 November 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-1949-9) contains supplementary material, which is available to authorized users.

Comparison of Stage and Lymph Node Ratio in Young and Older Patients with Colorectal Cancer Operated in a Tertiary Hospital in Nepal

“…2 According to the National health-program for colorectal cancer in Sweden, only 5% of all cases diagnosed from 2007-2011 occurred in patients less than 50 years of age. 3 A review of the Surveillance, Epidemiology, and End Results (SEER) database of 7661 patients in United States with colorectal cancer from 1973 to 2005 revealed increase in the incidence of carcinoma of rectum,especially in young patients with age less than 40 years. 4 Even in Asia, there is rapid increase in the burden of colorectal cancer with two to fourfold increase in countries like China, Singapore, Korea.…”

Prospective evaluation of muscle strength and spine joint motility of patients who underwent surgery for colorectal cancer by open and laparoscopic methods

“…After successful surgery, the incidence of sleeplessness decreased [13,14]. Research conducted by Ekblom-Bak et al and Onerup et al provides interesting conclusions: the authors found that increasing appropriate physical activities in the postoperative period can result in shorter convalescence times after surgery [15,16]. This type of solution is not realistically possible, however, to implement in medium-developed countries.…”

A pilot study: The association between physical activity level using by accelerometer and postoperative complications after hepatic resection

“…Furthermore, it is generally considered that a greater amount of daily physical activity reduces the likelihood of postoperative complications. Previously, a number of reports have demonstrated that a few weeks of a cardiopulmonary rehabilitation program prior to surgery reduces postoperative complications (27)(28)(29), and a randomized controlled trial is currently ongoing (30). Therefore, it is important to elucidate the association between the degree of daily physical activity prior to operation and postoperative complications.…”