The objective is to determine which preoperative physical functional factors or postoperative course influences the change in exercise capacity in patients after colorectal cancer surgery.
This study is a retrospective analysis of the data of patients who underwent radical colorectal cancer surgery in one hospital in Hakodate, Japan from January 2021 to March 2024. The change in exercise capacity was calculated by the ratio of the 6-minute walk distance (6MWD) test measured at discharge-assessment/preoperative-assessment. As preoperative physical functional factors, performance status (PS), grip strength, leg muscle strength (the ratio of knee extension muscle strength/body weight), gait velocity, and 6MWD were assessed. Postoperative course data, including the first day of 100 m gait acquisition, complications (≧GradeⅡ in Clavien-Dindo Classification), and the length of stay in the hospital, were collected from medical records. Multivariate linear regression analyses were performed with the dependent variable of the change in exercise capacity and with the independent variables of preoperative and postoperative factors to determine the association of those variables.
One hundred ninety-two patients were enrolled in this study (mean age 76.8 ± 5.7 years; 47% male; mean body mass index 23.5 ± 3.4). The mean change in exercise capacity was 0.89 ± 0.2, and thirty-four patients (18%) developed postoperative complications. In multivariate linear regression analysis, PS (β= −0.223, p = 0.002), leg muscle strength (β= 0.239, p = 0.003), 6MWD (β= −0.256, p = 0.023), and the first day of 100 m gait acquisition (β= −0.171, p = 0.033) were significantly associated with changes in exercise capacity (adjusted R2 = 0.137).
Good preoperative physical functional factors, including maintaining PS, leg muscle strength, and early postoperative gait acquisition, play an important role in preventing the loss of exercise capacity after colorectal cancer surgery. Regarding 6MWD, patients with lower preoperative exercise capacity were likely to show more improvement postoperatively, indicating exercise by physical therapy was more effective and beneficial.
The result of this study supports the importance of early physical therapy intervention before and after surgery. To prevent the loss of exercise capacity due to surgery, exercise should be aimed at improving PS, and leg muscle strength preoperatively and acquiring gait as early as possible postoperatively, especially for those with poor preoperative physical conditions.
preoperative physical functional factors
postoperative course
