Bor P1, Kingma BF2, Kerst A1, Steenhagen E3, Ruurda JP2, van Hillegersberg R2, Valkenet K1, Veenhof C1
1University Medical Centre Utrecht, Rehabilitation, Physiotherapy Science and Sports, Utrecht, Netherlands, 2University Medical Centre Utrecht, Surgery, Utrecht, Netherlands, 3University Medical Center, Utrecht University, Dietics, Utrecht, Netherlands
Background: Neoadjuvant chemoradiotherapy is frequently provided in patients awaiting esophagectomy for cancer with curative intent, which can negatively impact physical functioning. Previous studies suggests that the change in physical functioning during chemoradiotherapy may be a better indicator of postoperative complications compared to physical functioning measured at a single time point. However, literature is sparse regarding the potential association of change in physical functioning and nutritional status and the incidence of postoperative complications after esophagectomy for cancer.
Purpose: To investigate whether changes in physical functioning and nutritional status during neoadjuvant chemoradiotherapy are associated with the risk of postoperative complications after esophagectomy
Methods: Patients who received neoadjuvant chemoradiotherapy followed by esophagectomy between September 2016 and September 2018, were included for this prospective observational study. Physical functioning and nutritional status were measured before and after neoadjuvant therapy. Physical functioning included muscle strength (handgrip and leg extension, measured with hand held dynamometers) and exercise capacity (steep ramp test). Nutritional status included the weight, fat free mass index and nutritional status (patient-generated subjective global assessment). Multivariable logistic regression analyses were performed to evaluate whether changes in physical functioning and nutritional status were associated with the risk of developing postoperative complications.
Results: A total of 94 patients (until February 2018) were included in these preliminary analyses. During neoadjuvant chemoradiotherapy, muscle strength remained stable (handgrip strength (n=45) 36.2kg (SD 11.4) to 35.6kg (SD 10.9) p=0.527; leg extension (n=46) 390.5N (SD 81.9) to 394.9N (SD 95.7) p=0.840, while exercise capacity (n=45) decreased significantly with a mean difference of -16.0 Wpeak (SD 39.8) from 234.0 Wpeak (SD 69.0) to 218 Wpeak (SD 72.5) p=0.003. Multivariable logistic regression analysis showed that a negative change in handgrip strength was associated with an increased risk of postoperative pneumonia (no pneumonia: 1.36kg (SD 9.5), pneumonia: -11.64kg (SD 10.7), OR 0.859, CI: 0.767,0.962, p=0.008.
Conclusion(s): In these preliminary analyses, a negative change in handgrip strength during chemoradiotherapy was significantly associated with an increased risk of pneumonia after esophagectomy. For the congress in May 2019, the final analyses of the total population will be available.
Implications: The outcomes of this study will provide important insights in the relation between changes of physical functioning during neoadjuvant therapy and postoperative complications. This may provide direction for future research that aims to decrease postoperative complications after esophagectomy, possibly by standardized prehabilitation protocols.
Keywords: Preoperative, physical functioning, esophageal cancer
Funding acknowledgements: None, no funding to declare
Purpose: To investigate whether changes in physical functioning and nutritional status during neoadjuvant chemoradiotherapy are associated with the risk of postoperative complications after esophagectomy
Methods: Patients who received neoadjuvant chemoradiotherapy followed by esophagectomy between September 2016 and September 2018, were included for this prospective observational study. Physical functioning and nutritional status were measured before and after neoadjuvant therapy. Physical functioning included muscle strength (handgrip and leg extension, measured with hand held dynamometers) and exercise capacity (steep ramp test). Nutritional status included the weight, fat free mass index and nutritional status (patient-generated subjective global assessment). Multivariable logistic regression analyses were performed to evaluate whether changes in physical functioning and nutritional status were associated with the risk of developing postoperative complications.
Results: A total of 94 patients (until February 2018) were included in these preliminary analyses. During neoadjuvant chemoradiotherapy, muscle strength remained stable (handgrip strength (n=45) 36.2kg (SD 11.4) to 35.6kg (SD 10.9) p=0.527; leg extension (n=46) 390.5N (SD 81.9) to 394.9N (SD 95.7) p=0.840, while exercise capacity (n=45) decreased significantly with a mean difference of -16.0 Wpeak (SD 39.8) from 234.0 Wpeak (SD 69.0) to 218 Wpeak (SD 72.5) p=0.003. Multivariable logistic regression analysis showed that a negative change in handgrip strength was associated with an increased risk of postoperative pneumonia (no pneumonia: 1.36kg (SD 9.5), pneumonia: -11.64kg (SD 10.7), OR 0.859, CI: 0.767,0.962, p=0.008.
Conclusion(s): In these preliminary analyses, a negative change in handgrip strength during chemoradiotherapy was significantly associated with an increased risk of pneumonia after esophagectomy. For the congress in May 2019, the final analyses of the total population will be available.
Implications: The outcomes of this study will provide important insights in the relation between changes of physical functioning during neoadjuvant therapy and postoperative complications. This may provide direction for future research that aims to decrease postoperative complications after esophagectomy, possibly by standardized prehabilitation protocols.
Keywords: Preoperative, physical functioning, esophageal cancer
Funding acknowledgements: None, no funding to declare
Topic: Oncology, HIV & palliative care; Disability & rehabilitation
Ethics approval required: Yes
Institution: UMC Utrecht
Ethics committee: Medical Ethics Committee
Ethics number: 17-844
All authors, affiliations and abstracts have been published as submitted.
