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[Purpose] The purpose of this study was to investigate the interrelationship between different baseline functional capacity items, and their relationship with postoperative course in colorectal cancer patients. [Participants and Methods] This was a three-institution cohort study that included 127 patients scheduled for elective colorectal cancer surgery. Baseline functional capacity was evaluated using skeletal muscle index (SMI), six-minute walk test (6MWT), serum-albumin (Alb), vitality, and mental health before surgery. Postoperative findings, including C-reactive protein (CRP) levels 3 days post-operation, frequency of postoperative complications, and length of hospital stay (LOS), were evaluated based on the medical records. [Results] CRP was positively related to SMI, but negatively related to Alb level. LOS was negatively related to vitality. The 6MWT results and mental health-related findings were not significantly related to the postoperative course, but were directly and indirectly related to vitality, respectively. Alb level was also indirectly related to vitality through the 6MWT and mental health-related findings. The final constructed model demonstrated an acceptable fit to the data (goodness-of-fit index=0.958, adjusted goodness-of-fit index=0.930, comparative fit index=1.000, root mean square error of approximation=0.000). [Conclusion] Nutrition status, as measured by Alb level before surgery, may positively affect both the postoperative course and other functional capacity parameters.
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PURPOSE: This study investigated the impact of surgical treatment on the health-related quality of life (HRQOL) of Japanese patients with colorectal cancer (CRC). METHODS: This three-institution cohort study included 106 Japanese patients with CRC (69 men; mean age: 62.6 ± 12.4 years; age range = 30-85 years). HRQOL was evaluated using the Short-Form 36-Item Health Survey version 2 one to two days prior to surgery (baseline) and four weeks after surgery. Clinical characteristics, social characteristics, and HRQOL at baseline were investigated. RESULTS: Physical functioning, role-physical, bodily pain, and social functioning decreased significantly at four weeks after surgery compared with baseline, whereas mental health significantly improved. Physical functioning and general health perception showed an especially strong relation with the six-minute walk test (6MWT) at four weeks after surgery and HRQOL scores at baseline. The cutoff value for the 6MWT for clinically relevant improvement was 552.5 meters for physical functioning (area under curve [AUC] = 0.780, 95% confidence interval [CI] = 0.692-0.867) and 480.3 meters for general health perception (AUC = 0.721, 95% CI = 0.626-0.817). CONCLUSION: Patients with CRC could potentially improve their postoperative HRQOL by increasing their walking capacity post-surgery, and they may need follow-up interventions after discharge such as physical rehabilitation to do so. The results provide a potential pathway for improving HRQOL of Japanese patients with CRC.
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[Purpose] In this study, we investigated the preoperative and early postoperative health-related quality of life in patients who underwent surgical treatment for gastrointestinal cancer and also the factors that affect postoperative health-related quality of life. [Participants and Methods] The study included 198 patients who underwent elective surgery for gastrointestinal cancer (129 males and 69 females, age: 65.4 ± 11.8â years). Health-related quality of life was evaluated using the Short-Form 36-Item Health Survey version 2 at the following time points: 1-2 days preoperatively (baseline) and 4 weeks postoperatively. [Results] Compared with baseline levels, physical functioning, bodily pain, vitality, as well as physical, social, and emotional role functioning significantly decreased 4 weeks postoperatively. In contrast, compared with baseline levels, mental health significantly improved 4 weeks postoperatively. Physical functioning and general health evaluated 4 weeks postoperatively were significantly associated with income, baseline health-related quality of life, and the 6-minute walk test. [Conclusion] It is important to consider baseline income and health-related quality of life and increase postoperative exercise capacity to improve health-related quality of life in patients who undergo surgical treatment for gastrointestinal cancer.
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OBJECTIVES: Postoperative complications (PCs) in patients with gastrointestinal cancer (GIC) lead to reduced lifespan and poor quality of life. The aim of this study was to investigate the correlation between preoperative exercise-related factors, together with other contributory factors, and the frequency of PCs in patients with GIC. METHODS: This was a cross-sectional, three-institution study. We enrolled 299 patients who were scheduled for elective surgery for GIC (182 men and 117 women; age, 65.7 ± 11.0 years). PCs were graded using the Clavien-Dindo classification based on the medical records 1 month postoperatively. Exercise-related factors (the skeletal muscle index, the isometric knee extension torque, and the 6-min walk test [6 MWT] distance) were measured before surgery. Based on previous studies of factors contributing to complications, data on age, sex, clinical cancer stage, comorbidities, neoadjuvant therapy, type of surgery, surgery duration, blood loss, blood transfusion, laboratory data, respiratory function, body mass index, and visceral fat area were collected. RESULTS: The frequency of PCs was positively correlated with surgery duration (ß=0.427) and C-reactive protein (CRP) level on postoperative day 3 (ß=0.189). The 6 MWT was negatively correlated with the frequency of PCs through CRP level on postoperative day 3 (ß=-0.035). This model demonstrated an acceptable fit to the data (goodness-of-fit index, 0.979; adjusted goodness-of-fit index, 0.936; comparative fit index, 0.944; and root mean square error of approximation, 0.076). CONCLUSIONS: Preoperative walking capacity was correlated with PCs in patients undergoing GIC surgery. Prevention of PCs in patients with GIC requires the monitoring of both surgical parameters and postoperative inflammation.
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PURPOSE: The minimal clinically important difference (MCID) based on patient-reported outcomes is the smallest outcome change sufficiently significant to influence management and is crucial to the design and interpretation of comparative effectiveness trials. The purpose of this study was to estimate the MCID for postoperative recovery metrics in gastrointestinal cancer patients. METHODS: This was a three-institutional cohort study. Participants were 219 patients scheduled for gastrointestinal cancer elective surgery. Body mass index (BMI), isometric knee extension torque (IKET), 6-min walk test (6 MWT), and Short-Form 36-Item Health Survey (SF-36) version 2 were evaluated 1-2 days prior to surgery (baseline) and 4 weeks after surgery. Patients received postoperative rehabilitative care from a physical therapist during hospitalization. The MCID used anchor-based methods. The anchor was a score on the SF-36 physical functioning subscale greater or lower than the average score of the general Japanese population. RESULTS: The receiver operating curve indicated a cutoff value on the 6 MWT of -7.8 m for clinically relevant decline (area under curve [AUC] = 0.67, 95% confidence interval [CI] = 0.599-0.741) or a 1.5% change. The cutoff value on the SF-36 role-physical subscale was -34.4 for clinically relevant decline (AUC = 0.691, 95% CI = 0.621-0.761) or a 36.6% decrease. No significant correlation was found between changes in BMI, IKET, and anchor. CONCLUSION: Plausible MCIDs are present in patients with gastrointestinal cancer. These values can assist the interpretation of clinical trials and observation of the postoperative clinical course of gastrointestinal cancer surgery.
Subject(s)
Gastrointestinal Neoplasms , Minimal Clinically Important Difference , Cohort Studies , Gastrointestinal Neoplasms/surgery , Humans , Patient Reported Outcome Measures , Postoperative Period , Treatment OutcomeABSTRACT
BACKGROUND: The clinical importance of postoperative rehabilitation for cancer patients has recently attracted much attention. However, it remains uncertain whether early rehabilitation can prevent infectious complications in patients undergoing gastrointestinal cancer surgery. METHODS: The study group consisted of 259 patients who underwent laparoscopic or open surgery for gastrointestinal cancer at our institution between December 2012 and November 2016. Our department proposed a new early rehabilitation protocol for such patients to encourage physical activity after surgery. The protocol was clinically introduced on July 21, 2015. We divided the study subjects into two groups: those who were admitted before the introduction of the new protocol and those admitted after. The frequency of infectious complications, including respiratory infections, and the length of hospital stay after surgery were compared between the two groups. RESULTS: No adverse cardiovascular event associated with the early rehabilitation protocol was experienced. After the protocol was introduced, more than 80% of patients started exercising on the first day after surgery. For patients undergoing open surgery, the frequency of infectious complications was significantly reduced with the introduction of the protocol (p<0.05). Moreover, when open surgery was performed, the protocol significantly shortened the length of hospital stay (p<0.05). CONCLUSION: Our proposed early rehabilitation protocol for patients who have undergone gastrointestinal cancer surgery was considered to be safe and feasible. The protocol may prevent infectious complications and shorten the hospital stay after such surgery.
