Postoperative Exercise Training in Patients with Colorectal Liver Metastases A Randomized Controlled Trial.

IF 7.5 1区医学 Q1 SURGERY Annals of surgery Pub Date : 2024-11-11 DOI:10.1097/SLA.0000000000006587

Simon Nørskov Thomsen, Rikke Krabek, Christina Yfanti, Stine Sjöberg, Anna Sundberg, Ditte Munch Dalsgaard, Laura Mølgaard Thomsen, Eske Kvanner Aasvang, Camilla Qvortrup, Morten Mau-Sørensen, Bente Klarlund Pedersen, Peter Nørgaard Larsen, Martin Hylleholt Sillesen, Nicolai Aagaard Schultz, Jesper Frank Christensen, Casper Simonsen

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Abstract

Background: Postoperative morbidity can reduce quality of life, physical performance, and tolerability of postoperative chemotherapy in patients with colorectal liver metastases (CRLM). Exercise can improve these outcomes in some cancer populations. However, it remains unknown whether exercise can be delivered in the early postoperative period following surgery for CRLM without increasing the risk of harms.

Objective: The primary objective was to compare the number of serious adverse events (SAEs) with exercise intervention versus control. The secondary objectives were to compare non-SAEs, chemotherapy dose modifications, patient-reported outcomes, cardiorespiratory fitness, and physical performance.

Methods: Patients with CRLM scheduled to open surgery with or without postoperative chemotherapy were randomized 2:1 to intervention or control. The intervention group performed 30-50 min low-to-high intensity exercise 5 times/week for 8 weeks, initiated one day after postoperative hospital discharge. The primary outcome was SAEs. The secondary outcomes were SAEs; chemotherapy dose modifications; patient-reported outcomes; cardiorespiratory fitness; and physical performance.

Results: Fifty-five participants were randomized. The number of SAEs was similar between the groups (between-group difference [95% CI]: -0.07 [-0.59; 0.43] events), whereas the number of non-SAEs was lower in intervention (between-group difference [95% CI]: -4.65 [-9.14; -0.17] events). We found between-group differences in time to postoperative chemotherapy (intervention: 25 days, control; 42 days) and chemotherapy dose modifications (RR [95%CI]: 0.55 [0.35; 0.88]). Additionally, we found between-group differences in quality of life, cardiorespiratory fitness, and physical performance, in favor of intervention.

Conclusions: Early-onset postoperative exercise exhibit a favorable harms-benefit profile in patients with CRLM. This warrants further investigation in larger randomized controlled trials.

Trial registration: Prospectively registered at clinicaltrials.gov (NCT04751773).

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结直肠肝转移患者术后运动训练随机对照试验

背景：术后发病率会降低结直肠肝转移（CRLM）患者的生活质量、体能表现和对术后化疗的耐受性。在某些癌症人群中，运动可以改善这些结果。然而，在结直肠肝转移瘤术后早期进行锻炼是否不会增加危害风险，目前仍是未知数：首要目标是比较运动干预与对照组的严重不良事件（SAE）数量。次要目标是比较非SAEs、化疗剂量调整、患者报告结果、心肺功能和体能表现：方法：将计划接受开放手术并接受或不接受术后化疗的 CRLM 患者按 2:1 随机分为干预组和对照组。干预组在术后出院后一天开始进行30-50分钟的低强度至高强度运动，每周5次，持续8周。主要结果是 SAEs。次要结果为 SAEs、化疗剂量调整、患者报告结果、心肺功能和体能表现：结果：55 名参与者接受了随机治疗。两组的 SAE 数量相似（组间差异 [95% CI]：-0.07 [-0.59; 0.43] 例），而干预组的非 SAE 数量较低（组间差异 [95% CI]：-4.65 [-9.14; -0.17] 例）。我们发现术后化疗时间（干预组：25 天，对照组：42 天）和化疗剂量调整（RR [95%CI]：0.55 [0.35; 0.88]）存在组间差异。此外，我们还发现，在生活质量、心肺功能和体能表现方面，组间差异有利于干预：结论：对 CRLM 患者来说，术后早期运动具有良好的危害-收益分析。这值得在更大规模的随机对照试验中进一步研究：前瞻性注册于 clinicaltrials.gov (NCT04751773)。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.