Опубликовать статью

Информационное партнерство

Инфоресурсы

Контакты

«

Vol. 24, Art. 100 (pp. 1553-1574)    |    2023       

»

Short-course prehabilitation in colorectal cancer patients: interim results of a pilot randomized controlled trial

Zakharenko A.A., Zavgorodnyaya M.V., Sidorina A.S., Ten O.A., Potapchuk A.A., Shlyk I.V., Bagnenko S.F.
First Pavlov State Medical University of St. Petersburg
Russia, Saint Petersburg, L'va Tolstogo str. 6/8, 197022;

Brief summary

The task of prehabilitation is to increase the functional reserves of the body before surgery mainly due to moderate physical activity. In patients with colorectal cancer, its effect on reducing the incidence of postoperative complications, the duration of hospitalization and the start of adjuvant chemotherapy has been noted. However, the data of modern studies are contradictory. There is a lack of evidence base on optimal prehabilitation time, types of exercise and adherence to exercise in the domestic patient population. The aim of this study is to determine the effect of physical exercises as part of short-term (14 days) prehabilitation on increasing the functional reserves of the patient's organism, reducing postoperative complications, mortality, duration of hospitalization, and on the quality of life of patients. The results of the interim analysis of a pilot single-center prospective randomized clinical trial with two study groups conducted in the Department of Abdominal Oncology of the Pavlov State Medical University. The primary endpoint of the study is the dynamics of the value of the six-minute walk test (6MWT) before surgery, on the 30th and 90th days of the postoperative period, compared to the baseline result. Secondary endpoints: postoperative complications (according to the Clavien-Dindo classification); postoperative mortality at 30 and 90 days after surgery; postoperative hospitalization period; BMI dynamics; dynamics of hemoglobin, ferritin, iron, total protein, and albumin values; dynamics of the subjective assessment of physical activity scale (Borg scale); compliance with the LFC regimen (proportion of classes attended, proportion of exercise performed, number of steps walked, and energy expended over 14 days). Results. During from 01.12.2022 to 31.12.2023 39 people were included in the study, of whom 20 patients were randomized to the main group and 19 to the control group. Baseline indicators of the six-minute walk test at the time of analysis were the same in the studied groups. Before the operation, the indicators of the dynamics of the six-minute walk test relative to the initial values showed no statistical differences and their medians were the same in both groups +10m (-13 - +23) in the main group and +10m (-17 - +16) in the control group (p=0,564). On day 30 after surgery, patients in the prehabilitation group showed a smaller decrease in 6MWD results compared to the initial level of -22m (-42 - +7) than in the group of patients without prehabilitation -36m (-41 - - -16) (p=0,211). By 90 days in patients of the main group the test results become slightly better than the initial +15m (-21 - +48), and in patients of the control group - still do not reach the preoperative level -2m (-30 - +24) (p=0,229). No significant changes in the dynamics of BMI; in the values of hemoglobin, ferritin, iron, total protein, albumin were revealed. The effectiveness of correction of anemia, iron deficiency and protein status in both groups is noteworthy. Patients of the main group subjectively assessed the tolerability of the 6-minute walk test significantly better before and after surgery (p<0.05). The majority of patients in the main group, 19 (95%), chose home exercise. 18 patients (90%) performed the whole set of exercises - 6 sessions of 21 exercises. When comparing the number of steps and energy expended over 14 days - there was a significant difference in favor of the main group 64152 (54945-76213) vs 29763 (24519-54219) steps p<0.000 in the control group and 1380 (1219-1979) vs 670 (511-895) kcal respectively, p<0.000. The results of the interim analysis show the effectiveness of short-term unimodal prehabilitation in subjectively alleviating exercise tolerance. The developed exercise complex is safe. Good adherence of patients to the method of home exercises was noted.


Key words

prehabilitation, colorectal cancer, accelerated recovery after surgery, colon cancer surgery, compliance, nutritional therapy, physical therapy, psychological assistance.

Reference list

1. Sun Z. Determining the Optimal Timing for Initiation of Adjuvant Chemotherapy After Resection for Stage II and III Colon Cancer / Z Sun, MA Adam, J Kim, DP Nussbaum, E Benrashid, et al. // Dis Colon Rectum. 2016. 59(2):87-93


2. Gustafsson, U.O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations / U.O. Gustafsson, M.J. Scott, M Hubner et al. // World J Surg. 2018. 43, 659-695 (2019). https://doi.org/10.1007/s00268-018-4844-y


3. Makker, P.G.S. Preoperative functional capacity and postoperative outcomes following abdominal and pelvic cancer surgery: a systematic review and meta-analysis. / P.G.S Makker, C.E Koh., M.J Solomon. and D Steffens // ANZ Journal of Surgery. 2022. 92: 1658-1667. https://doi.org/10.1111/ans.17577


4. Zaharenko A.A. Preabilitaciya bolnih kolorektalnim rakom - sovremennoe sostoyanie problemi (obzor literatyri) / A.A. Zaharenko, M.V. Zavgorodnyaya, O.A. Ten, M.A. Belyaev, I.A. Paltishev, A.A. Tryshin, A.H. Hamid, K.N. Vovin, T.V. Kypenskaya // MEDLINE.RU. 2022, TOM 23, ONKOLOGIYa


5. Molenaar CJL. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. / CJL Molenaar, SJ van Rooijen, HJP Fokkenrood, RMH Roumen, L Janssen, GD Slooter. // Cochrane Database of Systematic Reviews. 2022. Issue 5. Art. No.: CD013259. DOI: 10.1002/14651858.CD013259.pub2.


6. Steffens D, Beckenkamp PR, Hancock M, et al. Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer. Br J Sports Med. 2018;52(5):344. doi: 10.1136/bjsports-2017-098032


7. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189-198. doi: 10.1097/SLA.0b013e31817f2c1a


8. Fearon KC, Ljungqvist O, Von Meyenfeldt M, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr. 2005;24(3):466-477. doi: 10.1016/j.clnu.2005.02.002


9. Mayo NE, Feldman L, Scott S, et al. Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Surgery. 2011;150(3):505-514. doi: 10.1016/j.surg.2011.07.045


10. Zaharenko A.A. Kratkosrochnaya preabilitaciya y bolnih kolorektalnim rakom - protokol randomizirovannogo klinicheskogo issledovaniya / A. A. Zaharenko, M. V. Zavgorodnyaya, A. A. Afanasev, A. A. Potapchyk // Koloproktologiya. 2023. T. 22, ? 2(84). - S. 70-78. - DOI 10.33878/2073-7556-2023-22-2-70-78. - EDN URKYDB.).