Berkel, A.E.M.

Bongers, Bart C.

Cuijpers, A C M

Dejong, C.H.C.

den Dulk, M.

Franssen, R.F.W.

Heldens, A.F.J.M.

Hildebrand, N D

Janssen-Heijnen, M.L.G.

Klaase, Joost M.

Lenssen, A.F.

Lubbers, T.

Olde Damink, S.W.M.

Rensen, S.S.

Stassen, L.P.S.

van Beijsterveld, C.A.F.M.

van Meeteren, N.L.U.

Vogelaar, J.

Voorn, M.J.J.

English

University of Groningen

   University of GroningenPreoperative optimization of diagnostic work-up and physical fitness with patients undergoingcancer surgeryBongers, Bart C.; Cuijpers, A C M; Voorn, M.J.J.; Franssen, R.F.W.; Hildebrand, N D ; Berkel,A.E.M.; Heldens, A.F.J.M.; van Beijsterveld, C.A.F.M.; Lubbers, T.; Vogelaar, J.IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2021Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Bongers, B. C., Cuijpers, A. C. M., Voorn, M. J. J., Franssen, R. F. W., Hildebrand, N. D., Berkel, A. E. M.,Heldens, A. F. J. M., van Beijsterveld, C. A. F. M., Lubbers, T., Vogelaar, J., Rensen, S. S., den Dulk, M.,Klaase, J. M., van Meeteren, N. L. U., Lenssen, A. F., Janssen-Heijnen, M. L. G., Dejong, C. H. C.,Stassen, L. P. S., & Olde Damink, S. W. M. (2021). Preoperative optimization of diagnostic work-up andphysical fitness with patients undergoing cancer surgery: Can we predict and improve outcome?. Postersession presented at Maastricht UMC+ Wetenschapsdag, Maastricht, Netherlands.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 20-11-2022Heldens et al. 2016 CRCThomas et al. 2019 CRC HPBvan Beijsterveld et al. 2020 HPB Berkel et al. 2021 CRCvan Wijk et al. submitted HPBFranssen et al. in progress CRCE.g., (impact of) complications, length of stay, functional recoveryE.g., survival, quality of l ifeThomas et al. 2019 CRC HPBBerkel et al. 2021 CRCHeldens et al. 2017 CRCBerkel et al. 2019 CRCvan Beijsterveld et al. 2019; 2020 HPBVoorn et al. 2021a; 2021b NSCLCCuijpers et al. 2021 CRCTimeSurgery DischargePrehabilitationPreoperativeE.g., 2 to 6 weeksPostoperative inpatientE.g., 2 to 14 daysPostoperativeE.g., 2 weeks to ...- In the right patients- At the right time- With the right content- In the right context- Time to recovery ê- Morbidity ê- Length of stay ê- Time to return to normal activities ê- 1- to 5-year survival é- Quality of life é???Critical   zoneAerobic fitnessMethodsAssociation between preoperative physical fitness and postoperative outcomes • Patient populations: prospective and retrospective cohort studies and systematic reviews, in patients with colorectal (CRC), liver or pancreatic (HPB), or non-small cell lung cancer (NSCLC)• Preoperative exercise tests: aerobic fitness (e.g., CPET, SRT, iSWT), muscle strength/endurance (e.g., HGS, FTSTST), functional mobility (e.g., TUG test, 2MWT)• Postoperative outcomes: incidence and impact of complications, length of stay, time to recovery of physical functioning• Analyses: univariate, logistic regression, and linear regression analysesEffects of preoperative physical exercise training (prehabilitation)• Study design and patient populations: a randomized clinical trial, pre-post studies, and a case study in high-risk patients (low preoperative aerobic fitness) with colorectal (including patients during neoadjuvant therapy in rectal cancer), liver, or pancreatic cancer• Preoperative intervention: community- or home-based supervised exercise prehabilitation (3-6 wks), outpatient supervised exercise prehabilitation during neoadjuvant therapy (9-17 wks) • Pre- and postoperative outcomes: feasibility (CRC, HPB), change in physical fitness (CRC, HPB), and postoperative outcomes (CRC)Aerobic fitnessTimeSurgeryPreoperativeE.g., 2 to 6 weeksPostoperative inpatientE.g., 2 to 14 daysDischargeShort-term outcomes? ? ? ? ? ? ? ? ? ? ? ? ? PostoperativeE.g., 2 weeks to ...Low aerobicfitness,high-riskpatients,worseoutcomesCritical   zoneLong-term outcomes?Better physical fitness,better short-term outcomes9 to 18%↑physical fitnessComplications40-50%↓Preoperative optimization of diagnostic work-upand physical fitness with patients undergoing cancer surgeryCan we predict and improve outcome?Correspondence to:Bart C. Bongers MSc PhD Medical physiologist, clinical exercise physiologist bart.bongers@maastrichtuniversity.nlwww.maastrichtuniversity.nlMaastricht UniversityDepartment of Nutrition and Movement SciencesP.O. Box 6166200 MD Maastricht, the Netherlands +31 43 38 816 21Aim To evaluate the association of preoperative physical fitness with postoperative outcomes in patients preparing for major elective cancer surgery, as well as the effect of exercise prehabilitation on postoperative outcomes, especially in patients characterized as high riskPostoperativeRMRPreoperative RMRAerobic fitness SurgeryPreoperative VO2 at VAT Postoperative VO2 at VATTimeVO2 at VATVO2 at VATIntroduction• Relatively high percentage (30-40%) of postoperative complications in patients undergoing major (elective) cancer surgery • Body has to cope with surgery-induced physiological stress response• Patients with a lower preoperative physical (aerobic) fitness might have a higher risk for adverse postoperative outcomes • Neoadjuvant therapy is known to preoperatively reduce physical (aerobic) fitness• It remains to be demonstrated whether exercise prehabilitation in these high-risk patients increases preoperative physical fitnessand improves postoperative outcomesConclusion Better preoperative physical fitness is associated with better postoperative outcomes in patients preparing for major elective cancer surgery. Short-term exercise prehabilitation by unfit patients improves preoperative physical fitness and seems to reduce both the incidence and impact of postoperative complications.Bongers BCa,b, Cuijpers ACMc,d, Voorn MJJe,f, Franssen RFWe,f, Hildebrand NDd,g, Berkel AEMb, Heldens AFJMh, van Beijsterveld CAFMh,i, Lubbers Tc,d, Vogelaar Jj, Rensen SSd,g, den Dulk Md, Klaase JMk, van Meeteren NLUl, Lenssen AFh, Janssen-Heijnen MLGe,f, Dejong CHCd,g, Stassen LPSc,g, Olde Damink SWMd,gaDepartment of Nutrition and Movement Sciences, NUTRIM, Maastricht University; bDepartment of Epidemiology, CAPHRI, Maastricht University; cDepartment of Surgery, GROW, Maastricht University; dDepartment of Surgery, Maastricht University Medical Center+; eDepartment of Epidemiology, GROW, Maastricht University; fDepartment of Clinical Epidemiology, VieCuri Medical Center; gDepartment of Surgery, NUTRIM, Maastricht University; hDepartment of Physical Therapy, Maastricht University Medical Center+; iCenter for Acute and Critical Care, Maastricht University Medical Center+; jDepartment of Surgery, VieCuri Medical Center; kDepartment of Hepatobiliary Surgery and Liver Transplantation, University Medical Center Groningen; lDepartment of Anesthesiology, Erasmus Medical CenterAbbreviations: RMR=resting metabolic rate; VAT=ventilatory anaerobic threshold; VO2=oxygen uptake.Abbreviations: CPET=cardiopulmonary exercise testing; CRC=colorectal cancer; FTSTST=five times sit-to-stand test; HGS=handgrip strength; HPB=hepatopancreatobiliary; iSWT=incremental shuttle walk test; NSCLC=non-small cell lung cancer; SRT=steep ramp test; TUG=timed up-and-go; 2MWT=two-minute walk test.E.g., survivalAssociation between preoperative physical fitness and postoperative outcomes ResultsEffects of preoperative physical exercise training (prehabilitation)

Preoperative optimization of diagnostic work-up and physical fitness with patients undergoing cancer surgery:Can we predict and improve outcome?

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Preoperative optimization of diagnostic work-up and physical fitness with patients undergoing cancer surgery:Can we predict and improve outcome?

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