D F J Dunne1,2, S Jack3, R P Jones1,2, L Jones1, D T Lythgoe4, H Z Malik1, G J Poston1, D H Palmer2,5, S W Fenwick1. 1. Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK. 2. Institute of Translational Medicine, University of Liverpool, Liverpool, UK. 3. National Institute for Health Research Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK. 4. Cancer Research UK, Liverpool Cancer Trials Unit, Liverpool, UK. 5. Clatterbridge Cancer Centre, Wirral, UK.
Abstract
BACKGROUND: Patients with low fitness as assessed by cardiopulmonary exercise testing (CPET) have higher mortality and morbidity after surgery. Preoperative exercise intervention, or prehabilitation, has been suggested as a method to improve CPET values and outcomes. This trial sought to assess the capacity of a 4-week supervised exercise programme to improve fitness before liver resection for colorectal liver metastasis. METHODS: This was a randomized clinical trial assessing the effect of a 4-week (12 sessions) high-intensity cycle, interval training programme in patients undergoing elective liver resection for colorectal liver metastases. The primary endpoint was oxygen uptake at the anaerobic threshold. Secondary endpoints included other CPET values and preoperative quality of life (QoL) assessed using the SF-36®. RESULTS:Thirty-eight patients were randomized (20 to prehabilitation, 18 to standard care), and 35 (25 men and 10 women) completed both preoperative assessments and were analysed. The median age was 62 (i.q.r. 54-69) years, and there were no differences in baseline characteristics between the two groups. Prehabilitation led to improvements in preoperative oxygen uptake at anaerobic threshold (+1·5 (95 per cent c.i. 0·2 to 2·9) ml per kg per min) and peak exercise (+2·0 (0·0 to 4·0) ml per kg per min). The oxygen pulse (oxygen uptake per heart beat) at the anaerobic threshold improved (+0·9 (0·0 to 1·8) ml/beat), and a higher peak work rate (+13 (4 to 22) W) was achieved. This was associated with improved preoperative QoL, with the overall SF-36® score increasing by 11 (95 per cent c.i. 1 to 21) (P = 0·028) and the overall SF-36® mental health score by 11 (1 to 22) (P = 0·037). CONCLUSION: A 4-week prehabilitation programme can deliver improvements in CPET scores and QoL before liver resection. This may impact on perioperative outcome. REGISTRATION NUMBER: NCT01523353 (https://clinicaltrials.gov).
RCT Entities:
BACKGROUND:Patients with low fitness as assessed by cardiopulmonary exercise testing (CPET) have higher mortality and morbidity after surgery. Preoperative exercise intervention, or prehabilitation, has been suggested as a method to improve CPET values and outcomes. This trial sought to assess the capacity of a 4-week supervised exercise programme to improve fitness before liver resection for colorectal liver metastasis. METHODS: This was a randomized clinical trial assessing the effect of a 4-week (12 sessions) high-intensity cycle, interval training programme in patients undergoing elective liver resection for colorectal liver metastases. The primary endpoint was oxygen uptake at the anaerobic threshold. Secondary endpoints included other CPET values and preoperative quality of life (QoL) assessed using the SF-36®. RESULTS: Thirty-eight patients were randomized (20 to prehabilitation, 18 to standard care), and 35 (25 men and 10 women) completed both preoperative assessments and were analysed. The median age was 62 (i.q.r. 54-69) years, and there were no differences in baseline characteristics between the two groups. Prehabilitation led to improvements in preoperative oxygen uptake at anaerobic threshold (+1·5 (95 per cent c.i. 0·2 to 2·9) ml per kg per min) and peak exercise (+2·0 (0·0 to 4·0) ml per kg per min). The oxygen pulse (oxygen uptake per heart beat) at the anaerobic threshold improved (+0·9 (0·0 to 1·8) ml/beat), and a higher peak work rate (+13 (4 to 22) W) was achieved. This was associated with improved preoperative QoL, with the overall SF-36® score increasing by 11 (95 per cent c.i. 1 to 21) (P = 0·028) and the overall SF-36® mental health score by 11 (1 to 22) (P = 0·037). CONCLUSION: A 4-week prehabilitation programme can deliver improvements in CPET scores and QoL before liver resection. This may impact on perioperative outcome. REGISTRATION NUMBER: NCT01523353 (https://clinicaltrials.gov).
Authors: An Ngo-Huang; Nathan H Parker; Xuemei Wang; Maria Q B Petzel; David Fogelman; Keri L Schadler; Eduardo Bruera; Jason B Fleming; Jeffrey E Lee; Matthew H G Katz Journal: Langenbecks Arch Surg Date: 2017-07-15 Impact factor: 3.445
Authors: Michael J Hughes; Rosie J Hackney; Peter J Lamb; Stephen J Wigmore; D A Christopher Deans; Richard J E Skipworth Journal: World J Surg Date: 2019-07 Impact factor: 3.352
Authors: Donald E Low; William Allum; Giovanni De Manzoni; Lorenzo Ferri; Arul Immanuel; MadhanKumar Kuppusamy; Simon Law; Mats Lindblad; Nick Maynard; Joseph Neal; C S Pramesh; Mike Scott; B Mark Smithers; Valérie Addor; Olle Ljungqvist Journal: World J Surg Date: 2019-02 Impact factor: 3.352
Authors: Enrico M Minnella; Rashami Awasthi; Sarah-Eve Loiselle; Ramanakumar V Agnihotram; Lorenzo E Ferri; Francesco Carli Journal: JAMA Surg Date: 2018-12-01 Impact factor: 14.766
Authors: L B VanWagner; M Serper; R Kang; J Levitsky; S Hohmann; M Abecassis; A Skaro; D M Lloyd-Jones Journal: Am J Transplant Date: 2016-03-29 Impact factor: 8.086
Authors: Jessica M Scott; Emily C Zabor; Emily Schwitzer; Graeme J Koelwyn; Scott C Adams; Tormod S Nilsen; Chaya S Moskowitz; Konstantina Matsoukas; Neil M Iyengar; Chau T Dang; Lee W Jones Journal: J Clin Oncol Date: 2018-06-12 Impact factor: 44.544