Endurance training alone was found to increase both lower extremity strength and endurance capacity .
Colorectal cancer surgery results in considerable postoperative morbidity , mortality and reduced quality of life .
As many patients will undergo additional (neo)adjuvant therapy , it is imperative that each individual optimize their physical function .
To eluci date the potential of exercise in patient optimization , we investigated the evidence for an exercise program before and after surgical treatment in colorectal cancer patients .
The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients.
BACKGROUND Neoadjuvant chemoradiotherapy ( NACRT ) followed by surgery for resectable locally advanced rectal cancer improves outcome compared with surgery alone . Our primary hypothesis was that NACRT impairs objective ly-measured physical fitness . We also wished to explore the relationship between fitness and postoperative outcome . METHOD In an observational study , we prospect ively studied 27 consecutive patients , of whom 25 undertook cardiopulmonary exercise testing ( CPET ) 2 weeks before and 7 weeks after st and ardized NACRT , then underwent surgery . In-hospital post-operative morbidity and mortality were recorded . Patients were followed up to 1 year for mortality . Data was analysed blind to clinical details . Receiver-operating characteristic ( ROC ) analysis defined the predictive value of CPET for in-hospital morbidity at day 5 . RESULTS Oxygen uptake ( [ Formula : see text ] in ml kg(-1 ) min(-1 ) ) at estimated lactate threshold ( θˆL ) and at peak exercise ( [ Formula : see text ] at peak in ml kg(-1 ) min(-1 ) ) both significantly decreased post-NACRT : [ Formula : see text ] at θˆL 12.1 ( pre-NACRT ) vs. 10.6 ( post-NACRT ) , p < 0.001 ( 95%CI -1.7 , -1.2 ) ; [ Formula : see text ] at peak 18.1 vs. 16.7 , p < 0.001 ( 95%CI -3.1 , -1.0 ) . Optimal [ Formula : see text ] at θˆL and peak pre-NACRT for predicting postoperative morbidity were 12.0 and 18.1 ( [ Formula : see text ] at θˆL - AUC = 0.71 , 77 % sensitive and 75 % specific ; [ Formula : see text ] at peak - AUC = 0.75 , 78 % sensitive and 76 % specific ) . Optimal [ Formula : see text ] at θˆL and peak post-NACRT for predicting postoperative morbidity were 10.7 and 16.7 ( [ Formula : see text ] at θˆL - AUC = 0.72 , 77 % sensitive and 83 % specific ; [ Formula : see text ] at peak - AUC = 0.80 , 85 % sensitive and 83 % specific ) . CONCLUSION NACRT before major rectal cancer surgery significantly decreased physical fitness as assessed by CPET . TRIALS REGISTRY NUMBER NCT01334593
Endurance training alone was found to increase both lower extremity strength and endurance capacity .
Colorectal cancer surgery results in considerable postoperative morbidity , mortality and reduced quality of life .
As many patients will undergo additional (neo)adjuvant therapy , it is imperative that each individual optimize their physical function .
To eluci date the potential of exercise in patient optimization , we investigated the evidence for an exercise program before and after surgical treatment in colorectal cancer patients .