Looby, Marina, Matthews, Lewis, West, Charles T, Khan, Kashuf, Ansell, Gillian, Donovan, Kathryn, Wood, Laura, Tapley, Patrick, Lewis, Rhys, Stoddard, Kate, Grocott, Michael P W, Jack, Sandy, Yano, Hideaki, Levett, Denny, Mirnezami, Alex and West, Malcolm A (2025) Physical fitness and body composition assessments in advanced cancer patients undergoing exenterative surgery - a pilot cohort study. Colorectal Disease, 27 (11), e70298. (doi:10.1111/codi.70298).
Abstract
AIM: Locally advanced pelvic malignancies, such as colorectal and anal cancers, can only be cured through multimodal cancer treatment including multi-visceral exenterative resections, which carry a high mortality and morbidity risk. Despite strong predictive abilities in other cancer cohorts, the combined prognostic value of body composition and cardiopulmonary exercise testing (CPET) for major in-hospital morbidity in patients undergoing exenterative surgery for advanced pelvic cancers has not been evaluated.
METHOD: A locally advanced colorectal and anal cancer cohort was derived from a prospectively maintained quaternary database. CPET was undertaken preoperatively, according to national guidelines. Skeletal muscle index (SMI) and radiation attenuation (SM-RA) were obtained from analysing L3 slices from preoperative computed tomography scans using SliceOmatic 5.0 and classified using predefined thresholds. Major morbidity was defined as Clavien-Dindo classification 3a or greater.
RESULTS: From 247 patients (58% male, median age 60 years), 62.4% and 35.5% had locally advanced or recurrent disease respectively. Physical fitness variables were significantly reduced in low SMI or low SM-RA patients. In multivariate linear regression, SMI was strongly predictive of oxygen uptake at the anaerobic threshold (B = 0.013, p = 0.001) and at peak (B = 0.015, p = 0.002). 17.3% of all patients experienced a major postoperative complication. In multivariate analysis, reduced peak power output (<1.5 W kg -1) was significantly associated with an increased risk of postoperative major morbidity (OR = 2.6, p = 0.012).
CONCLUSION: CPET may be predictive of in-hospital major morbidity in this cohort. The association of CPET with body composition necessitates further evaluation and external validation in a larger patient cohort, specifically interrogating their combined role in morbidity prediction and as a target for prehabilitation interventions.
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