ABSTRACT
Background:Controversial evidence currently exists regarding the feasibility and effectiveness to improve preoperative aerobic fitness during home-based prehabilitation in patients scheduled for liver or pancreatic resection, whereas morbidity rates are high following these resections. The primary aim of this study is to evaluate the preoperative oxygen uptake (VO2) at the ventilatory anaerobic threshold before and after a four-week home-based preoperative training program with nutritional supplementation in high-riskpatients scheduled for elective liver or pancreatic resection. Secondary aims are to evaluate program feasibility, immune system function, cardiopulmonary exercise test responses, individual progression profiles on training responses, quality of life, andpostoperative course.Methods:In this multicenter study with a pretest-posttest design, patients with a liver or pancreatic tumor scheduled for elective resection will be recruited. To select the high-risk fraction of this surgical population, their VO2at the ventilatory anaerobic threshold should be <11 ml/kg/min for final inclusion. A planned total of 24 high-risk patients will participate in a four-week (three sessions per week) home-based bimodal prehabilitation program. The partly supervised home-based preoperative training program consists of individualized goal setting followed by titration of interval and endurance training on an advanced cycle ergometer, combined with functional task exercises. Additionally, patients will be given protein and vitamin/mineral supplementation.Discussion: Effects of a partly supervised home-based bimodal prehabilitation regimen are unknown in high-risk patients opting for liver or pancreatic resection. Improved preoperative aerobic fitness might translate into improved postoperative outcomes and a reduced demand on care resources.Trial Registration:The study is registered in the Netherlands Trial Registry (NL6151) and was approved by the Institutional Ethics Committee, Twente, Enschede, the Netherlands (P17-08)
ABSTRACT
Background:Surgery-related muscle loss (SRML) occurs in at least one out of three cancer patients within one week after major surgery. Though, this important phenomenon has hardly been investigated.Methods:The MUSCLE POWERis a prospective, observational cohort study that investigates the presence, impact, and predictors for clinically relevant SRML in 178 cancer patients after major abdominal surgery using ultrasound measurements, squeeze and force measurements, and QoL questionnaires. Primary endpoint is the proportion of patients with clinically relevant SRML defined as ≥5% muscle loss within one week after surgery, measured by the cross-sectional area (CSA) of three different muscles:m. biceps brachii, m. rectus femoris, and m. vastus intermedius. Possible correlation with QoLand fatigue up to six months after surgery will be investigated. Daily physical activity during hospital stay will be monitored by a motility tracker, and protein intake will be monitored by a dietician. Possible predictors for clinically relevant SRML—consisting of age ≥65 years, preoperative diabetes, preoperative sarcopenia, major postoperative complications (Clavien-Dindo ≥III), insufficient physical activity, and insufficient postoperative protein intake—will be investigated with a multivariable logistic regression analyses with a backward stepwise approach. Variables with a p<0.05 will be retrained in the final multivariable model.Discussion: The MUSCLE POWERinvestigates the presence and impact of clinically relevant SRML in cancer patients after major abdominal surgery. Crucial information regarding possible predictors for clinically relevant SRML can be used in future intervention studies to prevent postoperative muscle loss and subsequently improve postoperative outcome and QoL.Trial Registration: Medical Ethics Committee of the University Medical Center Groningen, the Netherlands (METc2018/361, version 3.0, January 21, 2019), and Netherlands Trial Register ([NTR], NTR NL7505, version 1.0, February 7, 2019)