Objectively measured preoperative physical activity is associated with time to functional recovery after hepato-pancreato-biliary cancer surgery: a pilot study

Caspar F Mylius,Tim Takken,Daan J Lips,Cees P Van Der Schans,Joost M Klaase,Wim P Krijnen,Hasan Eker

doi:10.1186/s13741-021-00202-7

Abstract

BackgroundSurgical resection is currently the cornerstone of hepato-pancreato-biliary (HPB) cancer treatment. A low preoperative aerobic fitness level has been identified as a modifiable risk factor associated with complications after major abdominal surgery. A person’s aerobic fitness is influenced by performing moderate to vigorous physical activity (MVPA). This study aims to determine the activity monitor measured levels of MVPA performed among patients on the waiting list for HPB cancer surgery and their association with postoperative outcomes.MethodsA prospective, observational multi-center cohort pilot study was conducted. Patients enlisted for resection surgery on suspicion of HPB (pre)malignancy were enrolled. Performed MVPA was measured by an Actigraph wGT3X-BT. Additionally, aerobic fitness was measured via the Incremental Shuttle Walk Test, and (post)operative variables were collected from the electronic patient files. The association between MVPA and the pre- and postoperative variables was determined by univariate and multivariable (logistic) robust regression.ResultsA total of 38 participants, median age 66.0 (IQR 58.25–74.75) years, were enrolled. The median daily MVPA was 10.7 (IQR 6.9–18.0) min; only 8 participants met the Dutch MVPA guidelines. Participant’s age and aerobic fitness were associated with MVPA by multivariable statistical analysis. Time to functional recovery was 8 (IQR 5–12) days and was associated with MVPA and type of surgery (major/minor) in multivariable analysis.ConclusionSeventy-six percent of patients enlisted for resection of HPB (pre)malignancy performed insufficient MVPA. A higher level of MVPA was associated with a shorter time to functional recovery.

Highlights

Hepato-pancreato-biliary (HPB) cancer is a frequently diagnosed disease with an incidence of 248,800 patients diagnosed with HPB cancer in Europe in 2018, of which pancreatic cancer constituted the majority with 132,600 diagnoses (Ferlay et al 2018)
This study aims to determine the activity monitor measured levels of moderate to vigorous physical activity (MVPA) performed among patients on the waiting list for HPB cancer surgery
Two participants were excluded from physical activity (PA) analysis due to not meeting wear-time criteria; the measurements from the remaining 38 participants were used for further analysis

Summary

Introduction

Hepato-pancreato-biliary (HPB) cancer is a frequently diagnosed disease with an incidence of 248,800 patients diagnosed with HPB cancer in Europe in 2018, of which pancreatic cancer constituted the majority with 132,600 diagnoses (Ferlay et al 2018). Since complications and mortality rates following pancreatic and liver surgery increase with advancing age (Raill 2009), identifying modifiable risk factors in HPB cancer patients may help to reduce postoperative complications, LOS, and hospital costs (Straatman et al 2015). Low preoperative aerobic fitness is associated with negative postoperative outcomes such as prolonged LOS and increase in incidence of unplanned readmissions, morbidity, and mortality after major intraabdominal surgery (Moran et al 2016a; Chandrabalan et al 2013). A low preoperative aerobic fitness level has been identified as a modifiable risk factor associated with complications after major abdominal surgery. This study aims to determine the activity monitor measured levels of MVPA performed among patients on the waiting list for HPB cancer surgery and their association with postoperative outcomes

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