Physical fitness and body composition assessments in advanced cancer patients undergoing exenterative surgery - A pilot cohort study.

Reduced peak power output was significantly associated with an increased risk of major postoperative morbidity in multivariate analysis.

• Peak power output threshold was <1.5 W/kg
• Odds ratio of 2.6 (p = 0.012) for major postoperative morbidity
• Major morbidity was defined as Clavien-Dindo classification 3a or greater
• 17.3% of all patients experienced a major postoperative complication

Skeletal muscle index (SMI) was strongly predictive of oxygen uptake at the anaerobic threshold and at peak exercise in multivariate linear regression.

• SMI predicted oxygen uptake at anaerobic threshold (B = 0.013, p = 0.001)
• SMI predicted oxygen uptake at peak (B = 0.015, p = 0.002)
• SMI was derived from L3 CT slice analysis using SliceOmatic 5.0
• Findings indicate a strong association between body composition and cardiopulmonary fitness

Physical fitness variables were significantly reduced in patients with low SMI or low skeletal muscle radiation attenuation (SM-RA).

• Low SMI and low SM-RA were classified using predefined thresholds
• Both SMI and SM-RA were obtained from preoperative CT scan L3 slices
• This finding applied across the full cohort of 247 patients

The study cohort consisted of 247 patients with locally advanced or recurrent pelvic malignancies undergoing exenterative surgery.

• 58% of patients were male with a median age of 60 years
• 62.4% had locally advanced disease and 35.5% had recurrent disease
• Data were derived from a prospectively maintained quaternary database
• CPET was undertaken preoperatively according to national guidelines

The combined prognostic value of body composition and CPET for major in-hospital morbidity in exenterative surgery patients had not previously been evaluated.

• Prior literature demonstrates strong predictive abilities of these measures in other cancer cohorts
• The study focused on locally advanced colorectal and anal cancers requiring multi-visceral exenterative resections
• Exenterative surgery carries high mortality and morbidity risk
• The authors identified a gap necessitating further evaluation and external validation in a larger cohort