Major Abdominal Cancer Surgery Research Articles

Comparing analgesic efficacy of peripheral nerve blocks with thoracic epidural block after major abdominal cancer surgery: Study design is important

Journal of Surgical OncologyVolume 125, Issue 3 p. 548-549 LETTER TO THE EDITOR Comparing analgesic efficacy of peripheral nerve blocks with thoracic epidural block after major abdominal cancer surgery: Study design is important Wen-Xuan Chen, Wen-Xuan Chen Sixth Clinical Medical College and Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorFu-Shan Xue, Corresponding Author Fu-Shan Xue [email protected] [email protected] orcid.org/0000-0002-1028-6036 Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China Correspondence Fu-Shan Xue, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Beijing 100050, China. Email: [email protected]; [email protected]Search for more papers by this authorCheng-Wen Li, Cheng-Wen Li Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this author Wen-Xuan Chen, Wen-Xuan Chen Sixth Clinical Medical College and Beijing Anzhen Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this authorFu-Shan Xue, Corresponding Author Fu-Shan Xue [email protected] [email protected] orcid.org/0000-0002-1028-6036 Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China Correspondence Fu-Shan Xue, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Beijing 100050, China. Email: [email protected]; [email protected]Search for more papers by this authorCheng-Wen Li, Cheng-Wen Li Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, ChinaSearch for more papers by this author First published: 17 January 2022 https://doi.org/10.1002/jso.26777 Re: Aiken TJ, et al: . Peripheral nerve blocks with liposomal bupivacaine are associated with increased opioid use compared to thoracic epidural in patients with an epigastric incision. J Surg Oncol. 2021 Oct 7. doi:10.1002/jso.26711 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume125, Issue3March 2022Pages 548-549 RelatedInformation

Prophylaxis Extension for VENous Thromboembolism Following Major Abdominal and Pelvic Surgery for Cancer (PREVENT): Quality Improvement Transitioned into a Cohort Study

Introduction: Extended venous thromboembolism (VTE) prophylaxis following abdominopelvic cancer surgery has not been widely adopted. We compared outcomes of patients pre- and post-implementation of extended VTE prophylaxis with low molecular weight heparin.

Perioperative Short Term Prophylaxis against Deep Vein Thrombosis after Major Abdominal Cancer Surgery: Retrospective Cohort Study.

PurposeThe aim of this study is to evaluate the outcomes of pharmacological thromboprophylaxis given for short-term duration to the patients who underwent major abdominal surgery for colorectal and gastric cancer.MethodsMaterials and This retrospective cohort study was performed in consecutive patients who underwent major abdominal surgery for colorectal and gastric cancer and received short-term pharmacological thromboprophylaxis during hospital stay were enrolled. Complete duplex ultrasonography of the lower limbs was performed for all patients to investigate both symptomatic and asymptomatic deep vein thrombosis (DVT).ResultsOverall, 278 patients were evaluated for inclusion and 62 colorectal and 27 gastric cancer patients were enrolled. Of 89 patients, the incidence of total and symptomatic DVT was 4.5% and 2.2%, respectively. The patients with symptomatic DVT were diagnosed within the first four months. The incidence of coronary artery disease, mucinous adenocarcinoma and vascular tumor invasion were significantly higher in patients with DVT (P-values<0.001, 0.009, and 0.02, respectively).ConclusionShort-term pharmacological thromboprophylaxis after major abdominal surgery for colorectal and gastric cancer does not increase symptomatic DVT rates of patients with low Caprini score. Postoperative DVT surveillance may benefit patients with coronary artery disease, mucinous adenocarcinoma or vascular invasion of the tumor.

Accuracy of vital parameters measured by a wearable patch following major abdominal cancer surgery

IntroductionRecent advances in wearable technology allow for the development of wirelessly connected sensors to continuously measure vital parameters in the general ward or even at home. The present study assesses the accuracy of a wearable patch (Healthdot) for continuous monitoring of heartrate (HR) and respiration rate (RR). Materials and methodsThe Healthdot measures HR and RR by means of chest accelerometry. The study population consisted of patients following major abdominal oncological surgery. The analysis focused on the agreement between HR and RR measured by the Healthdot and the gold standard patient monitor in the intensive and post-anesthesia care unit. ResultsFor HR, a total of 112 h of measurements was collected in 26 patients. For RR, a total of 102 h of measurements was collected in 21 patients. On second to second analysis, 97% of the HR and 87% of the RR measurements were within 5 bpm and 3 rpm of the reference monitor. Assessment of 5-min averaged data resulted in 96% of the HR and 95% of the RR measurements within 5 bpm and 3 rpm of the reference monitor. A Clarke error grid analysis showed that 100% of the HR and 99.4% of the 5-min averaged data was clinically acceptable. ConclusionThe Healthdot accurately measured HR and RR in a cohort of patients recovering from major abdominal surgery, provided that good quality data was obtained. These results push the Healthdot forward as a clinically acceptable tool in low acuity settings for unobtrusive, automatic, wireless and continuous monitoring.

The Efficacy of Preoperative Duloxetine in Patients Undergoing Major Abdominal Cancer Surgery: A Randomized Controlled Trial.

We aimed to evaluate the analgesic efficacy as well as the postoperative quality of recovery of preoperative oral duloxetine a serotonin and norepinephrine reuptake inhibitor for patients undergoing major abdominal cancer surgery. Sixty-two patients, undergoing major abdominal cancer surgery were divided into 2 equal groups, received oral duloxetine 60 mg (2 h preoperative) or placebo. Postoperative 48 hours morphine consumption, visual analog scale pain score, and quality of recovery were measured. The cumulative 48 hours morphine consumption was significantly reduced in the duloxetine group compared with the placebo group (mean±SD) (5.2±3.2 vs. 12.9±3.4 mg), mean difference (95% confidence interval) 7.6 mg (5.9-9.3) P<0.001. The time to first morphine request was delayed significantly in the duloxetine group, median (interquartile range), 25 (19 to 38) versus 8 (4 to 9) hours, P<0.001. The duloxetine group had lower pain scores than the placebo group at 8, 12, 16, and 24 hours postoperatively, however, nonsignificant changes were observed at 0, 2, 4, 36, and 48 hours postoperatively. Participants in the duloxetine group had a better postoperative quality of recovery than the placebo group. The median (interquartile range) of the global quality of recovery-40 scoring system for the duloxetine group was 185 (180 to 191) compared with 170 (163 to 175) in the placebo group (P<0.001). A single preoperative dose of oral duloxetine, 60 mg for patients subjected to major abdominal cancer surgery reduced postoperative pain, decreased opioid consumption, and improved the quality of recovery.

SupPoRtive Exercise Programmes for Accelerating REcovery after major ABdominal Cancer surgery trial (PREPARE-ABC): Pilot phase of a multicentre randomised controlled trial.

PREPARE-ABC is a pragmatic multicentre randomised controlled trial including an internal pilot designed to assess the clinical and cost-effectiveness of pre- and postoperative exercise in relation to short- and longer-term postoperative recovery outcomes in colorectal cancer patients undergoing surgical resection. Here, we report on internal pilot phase data for the first 200 patients randomised to the trial, which included prespecified stop-go criteria used to inform the decision to progress to the fully powered trial by the funder. Eligible and consenting patients are randomly assigned (1:1:1) to hospital-supervised exercise, home-supported exercise or treatment as usual (TAU). Randomisation is concealed but clinical teams providing treatment and participants are unmasked. Primary outcomes are 30-day morbidity (Clavien-Dindo) and 12-month health-related quality of life (Medical Outcomes Study Health Questionnaire). Here, we present findings from the prespecified pilot phase which assessed feasibility of site set up, recruitment, adherence and acceptability of trial processes to patients and site staff. Between 9 November 2016 and 18 May 2018, 18sites were set up, with 200 patients randomised to either hospital-supervised exercise (68), home-supported exercise (69) or treatment as usual (TAU) (63). Across the groups, 19 patients did not proceed to surgery or withdrew and 52% experienced a complication. Over half of the participants (57%) in the hospital-supervised group attended ≥6 preoperative sessions and 50% attended ≥5monthly postoperative exercise "booster sessions". In the home-supported group, 70% patients engaged with ≥2 telephone support sessions in the preoperative phase and 80% engaged in ≥5monthly telephone support "booster sessions". Adverse events were reported by 22 patients and three patients reported a serious adverse event. The majority of complications were Clavien-Dindo grades 1-2; however, 16 patients experienced one or more Clavien-Dindo grade 3-4 complication(s). Results of the internal pilot phase confirm the feasibility of site set-up and patient recruitment, representativeness of the sample population and adequate adherence to hospital-supervised and home-supported exercise. On the basis of these positive results, progression to the fully-powered trial was authorised by the funder.

SupPoRtive Exercise Programmes for Accelerating REcovery after major ABdominal Cancer surgery trial (PREPARE‐ABC): Study protocol for a multicentre randomized controlled trial

Exercise programmes can increase cardiopulmonary reserve and functional capacity prior to surgery and can improve clinical, functional and survival outcomes after a colorectal cancer diagnosis. However, the impact of pre- and postoperative exercise on postoperative recovery outcomes and longer-term health-related quality of life are unknown; thus, there is a need for high-quality randomized controlled trials. SupPoRtive Exercise Programmes for Accelerating REcovery after major Abdominal Cancer surgery (PREPARE-ABC) is a three-arm multicentre randomized controlled trial with internal pilot. The primary objective is to assess the effects of pre- and postoperative exercise on surgical outcomes and longer-term health-related quality of life in cancer patients undergoing colorectal resection. The aim of PREPARE-ABC is to randomize 1146 patients at the individual level (1:1:1) to hospital-supervised exercise, home-supported exercise or treatment as usual. The primary outcomes are short-term (30-day) morbidity, assessed using the Clavien-Dindo classification, and longer-term health-related quality of life, assessed using the Medical Outcomes Study Health Questionnaire (36-item Short-Form Survey [SF-36]). Secondary outcomes include cardiopulmonary fitness, physical activity behaviour change, psychological health status and cost-effectiveness. A process evaluation of intervention delivery and usual care also will be undertaken. This is the first UK-based definitive randomized controlled trial to investigate the effects of pre- and postoperative exercise on short-term postoperative health outcomes and longer-term health-related quality of life in colorectal cancer patients. The trial will yield robust clinical and cost-effectiveness data to underpin clinical guidance on how exercise programmes should be implemented in the routine management of patients undergoing major colorectal cancer surgery.

What matters to you? An investigation of patients' perspectives on and acceptability of prehabilitation in major cancer surgery.

To understand perspectives on and acceptability of prehabilitation among patients undergoing complex abdominal cancer surgery (cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy). Seventy-nine patients admitted to a Danish colorectal or ovarian cancer centre participated in qualitative semi-structured interviews and/or registered their prehabilitation activities based on preoperative recommendations presented in a leaflet. Malterud's principles of systematic text condensation were used to analyse the interview data, and descriptive statistics were used to describe the activity registrations. Five domains clarify central aspects of the patients' perspectives on and acceptability of prehabilitation: the preoperative period, attitudes towards prehabilitation, the actual prehabilitation performed, motivation to take action and the need for support. Patients undergoing major abdominal cancer surgery are interested in and positive towards prehabilitation, but it has to be on their terms. The patients need support and supervision, but it has to be provided in a setting and in a way that are in line with the patient's preferences, resources and values. Thus, patient involvement is necessary to create prehabilitation programmes that are feasible and fit into patients' everyday lives.

Preoperative physical exercise strategies for patients undergoing major abdominal cancer surgery: a scoping review.

Although preoperative physical exercise has been demonstrated to be associated with clinical improvements among abdominal cancer patients, there remains heterogeneity in exercise strategies and uncertainty of what the optimal strategies should be. This scoping review aimed to review and summarize the existing knowledge about preoperative exercise strategies for abdominal cancer patients. The Joanna Briggs Institute (JBI) framework for conducting scoping reviews was adopted to investigate preoperative physical exercise strategies for patients undergoing major abdominal cancer surgery. A total of 1563 studies were identified and 24 were included in this review. Most of the study populations were colorectal cancer (n = 14). The most common type of exercise was a combination of aerobic and resistance exercises (n = 19). The most common form of aerobic exercise was walking (n = 13) or cycling (n = 12). Most resistance exercises were targeting at major muscle groups (n = 12). Most of the studies were performed at moderate intensity (n = 14) with frequency of 2 ~ 3 times/week (n = 14). The time of a training session was 30 ~ 60min in half studies (n = 12). The intervention duration for most studies was less than 4weeks (n = 11). Exercise locations included home (n = 10), facility (n = 7), and a combination of home and facility (n = 5). Phone calls were utilized by nearly half of the home-based exercise studies to supervise the exercise adherence (n = 7). This review provides a comprehensive summary of preoperative physical exercise strategies. It has the potential to inform clinical practice and future studies.

Actual postoperative protein and calorie intake in patients undergoing major open abdominal cancer surgery: A prospective, observational cohort study.

BackgroundAdequate nutritional protein and energy intake are required for optimal postoperative recovery. There are limited studies reporting the actual postoperative protein and energy intake within the first week after major abdominal cancer surgery. The main objective of this study was to quantify the protein and energy intake after major abdominal cancer surgery.MethodsWe conducted a prospective cohort study. Nutrition intake was assessed with a nutrition diary. The amount of protein and energy consumed through oral, enteral, and parenteral nutrition was recorded and calculated separately. Based on the recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN), protein and energy intake were considered insufficient when patients received <1.5 g/kg protein and 25 kcal/kg for 2 or more days during the first postoperative week.ResultsFifty patients were enrolled in this study. Mean daily protein and energy intake was 0.61 ± 0.44 g/kg/day and 9.58 ± 3.33 kcal/kg/day within the first postoperative week, respectively. Protein and energy intake were insufficient in 45 [90%] and 41 [82%] of the 50 patients, respectively. Patients with Clavien‐Dindo grade ≥III complications consumed less daily protein compared with the group of patients without complications and patients with grade I or II complications.ConclusionDuring the first week after major abdominal cancer surgery, the majority of patients do not consume an adequate amount of protein and energy. Incorporating a registered dietitian into postoperative care and adequate nutrition support after major abdominal cancer surgery should be a standard therapeutic goal to improve nutrition intake.

Intraoperative Temperature Monitoring with Zero Heat Flux Technology (3M SpotOn Sensor) in Comparison with Tympanic and Oesophageal Temperature and Hypotermia Risk Factors: An Observational Study.

ObjectiveInadvertent hypothermia (body temperature below 35°C) is a common and avoidable challenge during surgery under anaesthesia. It is related to coagulation (clotting) disorders, an increase in blood loss, and a higher rate of wound infection. One of the methods for non-invasive monitoring of the core body temperature is the 3M SpotOn zero heat flux method. In this approach, sensors placed at the frontal region of the patient measure the skin temperature by creating an isothermic channel. The study aimed to determine the risk factors for hypothermia and compare the 3M SpotOn zero heat flux method with the tympanic membrane (eardrum) and oesophageal (food pipe) temperature measurement methods.DesignObservational.Data sourcesThe patients’ data were collected, including age, gender, weight, BMI, other illnesses, smoking history, type of anaesthesia, duration of surgery, operating room temperature, pulse rate, blood pressure, blood loss, and transfusions. Body temperature was measured by the tympanic membrane method before and after surgery, oesophageal method during surgery, and SpotOn measurements throughout all three periods were recorded.Eligibility criteriaInclusion criteria was: adult patients, both genders, who had undergone major abdominal cancer surgery at the trialists’ institution, in whom the SpotOn zero heat flux, tympanic membrane, and oesophageal temperature measurement methods had all been used. Participant exclusion criteria was the absence of recorded data.ResultsIn this study, inadvertent intraoperative hypothermia incidence was 38.1% in the recovery room. Although gender, presence of comorbidities, history of smoking, administration of epidural anaesthesia, and requirement of blood transfusion [red blood cells (RBCs) and fresh frozen plasma (FFP)] did not affect hypothermia significantly during admission to the recovery room, prewarming the patient throughout the operation prevented the occurrence of hypothermia significantly (p=0.004). Additionally, as the American Society of Anaesthesiologists (ASA) physical status score worsened, the rate of hypothermia increased significantly (Frequency: 1st degree, 29.4%; 2nd degree, 47.5%; 3rd degree, 66.7%; X2Slope- p=0.047).ConclusionThe most significant risk factor was found to be not prewarming the patient as a strict procedure, and as the ASA physical status score worsened, the rate of hypothermia increased significantly. Besides, the SpotOn method provided temperature measurements as good as the oesophageal temperature measurements. Clinical Trial registration: ISRCTN 14027708.

Prehabilitation with wearables versus standard of care before major abdominal cancer surgery: a randomised controlled pilot study (trial registration: NCT04047524)

BackgroundPrehabilitation aims to improve post-operative outcomes by enhancing pre-operative fitness but is labour-intensive. This pilot study aimed to assess the efficacy of a tri-modal prehabilitation programme delivered by smartwatches for improving functional fitness prior to major abdominal cancer surgery.MethodsA single-centre, randomised controlled pilot study, in which 22 patients were randomised to: (a) a prehabilitation group (n = 11), comprising of home-based exercise, nutritional, and dietary advice delivered using a wrist-worn smartwatch connected to a smartphone application; or (b) a control group (n = 11) receiving usual care, with patients given a smartwatch as a placebo. Eligible participants had over two weeks until planned surgery. The primary outcome was pre-operative physical activity including 6-min walk test (6MWT) distance, with secondary outcomes including change in body weight and hospital anxiety and depression score (HADS).ResultsRecruitment was 67% of eligible patients, with groups matched for baseline characteristics. The prehabilitation group engaged in more daily minutes of moderate [25.1 min (95% CI 9.79–40.44) vs 13.1 min (95% CI 5.97–20.31), p = 0.063] and vigorous physical activity [36.1 min (95% CI 21.24–50.90) vs 17.5 min (95% CI 5.18–29.73), p = 0.022] compared to controls. They also had significantly greater improvements in 6MWT distance compared to controls [+ 85.6 m (95% CI, + 18.06 to + 153.21) vs + 13.23 m (95% CI − 6.78 to 33.23), p = 0.014]. HADS scores remained unchanged from baseline in both groups.ConclusionPrehabilitation in the colorectal cancer care setting can be delivered using smartwatches and mobile applications. Furthermore, this study provides early indicative evidence that such technologies can improve functional capacity prior to surgeryTrial registrationNCT04047524.

Multicenter Prospective Cohort Study of the Patient-Reported Outcome Measures PRO-CTCAE and CAT EORTC QLQ-C30 in Major Abdominal Cancer Surgery (PATRONUS): A Student-Initiated German Medical Audit (SIGMA) Study

BackgroundThe patient-reported outcomes (PRO) version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) and the computerized adaptive testing (CAT) version of the EORTC quality-of-life questionnaire QLQ-C30 have been proposed as new PRO measures in oncology; however, their implementation in patients undergoing cancer surgery has not yet been evaluated.MethodsPatients undergoing elective abdominal cancer surgery were enrolled in a prospective multicenter study, and postoperative complications were recorded according to the Dindo–Clavien classification. Patients reported PRO data using the CAT EORTC QLQ-C30 and the PRO-CTCAE to measure 12 core cancer symptoms. Patients were followed-up for 6 months postoperatively. The study was carried out by medical students of the CHIR-Net SIGMA study network.ResultsData of 303 patients were obtained and analyzed across 15 sites. PRO-CTCAE symptoms ‘poor appetite’, ‘fatigue’, ‘exhaustion’ and ‘sleeping problems’ increased after surgery and climaxed 10–30 days postoperatively. At 3–6 months postoperatively, no PRO-CTCAE symptom differed significantly to baseline. Patients reported higher ‘social functioning’ (p = 0.021) and overall quality-of-life scores (p < 0.05) 6 months after cancer surgery compared with the baseline level. There was a lack of correlation between postoperative complications or death and any of the PRO items evaluated. Feasibility endpoints for student-led research were met.ConclusionThe two novel PRO questionnaires were successfully applied in surgical oncology. Postoperative complications do not affect health-reported quality-of-life or common cancer symptoms following major cancer surgery. The feasibility of student-led multicenter clinical research was demonstrated, but might be enhanced by improved student training.

Preoperative standardized phase angle at bioimpedance vector analysis predicts the outbreak of antimicrobial-resistant infections after major abdominal oncologic surgery: A prospective trial

ObjectivesInfectious morbidity is the most common and costly among all surgery-related complications, and infections by multidrug-resistant microorganisms (MDR) are associated with poor outcomes. Derangements of body composition is a recognized risk factor for infections. The aim of this study was to investigate the potential association between specific traits of body composition and the risk of having MDR-related infections. MethodsThis was a prospective study with patients scheduled for major abdominal surgery for gastrointestinal cancer. Bioimpedance vector analysis (BIVA), a reliable tool for body composition assessment, was performed the day before the operation. Postoperative complications were collected focusing on resistance patterns and site of infection. Patterns of resistance were compared with BIVA parameters. ResultsData from 182 patients suffering from pancreatic (n = 76, 41.7%), rectal (n = 38, 20.9%), gastric (n = 31, 17%), or hepatic (n = 37, 20.3%) malignancy were collected. Overall complications occurred in 108 patients (59%), and in 45 patients (28%) bacterial infections were proven at culture. Of these, 15 (8%) were multidrug-sensitive (MDS), 38 MDR, and 2 extended drug-resistant (XDR) infections. The standardized phase angle measured (SPA) at BIVA was significantly lower in the MDR/XDR infections (–0.02 ± 1.20) than for no infection/MDS (0.56 ± 1.53; P = 0.029). A multivariate analysis showed that SPA was the only independent variable for MDR/XDR infections with an odds ratio of 3.057 (95% confidence interval, 1.354–6903; P = 0.007). The predictive ability of SPA revealed an area under the receiver operating characteristic curve of 0.662, with an optimal threshold of –0.3. ConclusionsIn surgical cancer patients, preoperative value of SPA lower than -0.3 is associated with the outbreak of MDR bacterial infections.

Feasibility and acceptability of a preoperative exercise program for patients undergoing major cancer surgery: results from a pilot randomized controlled trial

ObjectiveTo establish the feasibility and acceptability of a preoperative exercise program, and to obtain pilot data on the likely difference in key surgical outcomes to inform the sample size calculation for a full-scale trial.DesignPilot randomized controlled trial.SettingRoyal Prince Alfred Hospital, Sydney, Australia.SubjectsWe included patients undergoing elective pelvic exenteration or cytoreductive surgery aged 18 to 80 years, who presented to the participating gastrointestinal surgeon at least 2 weeks prior to surgery. Patients presenting cognitive impairment, co-morbidity preventing participation in exercise, inadequate English language, currently participating in an exercise program or unable to attend the exercise program sessions were excluded.MethodsParticipants were randomized to a 2–6 weeks preoperative, face-to-face, individualised exercise program or to usual care. Feasibility was assessed with consent rates to the study, and for the intervention group, retention and adherence rates to the preoperative exercise program. Acceptability of the exercise program was assessed with a semi-structured questionnaire exploring the advice received and the amount, duration and intensity of the exercise program. In addition, postoperative complication rates (Clavien-Dindo), length of hospital stay and self-reported measures of health-related quality of life (SF-36v2) were collected at baseline, day before surgery and in-hospital up to discharge from hospital.ResultsOf 122 patients screened, 26 (21%) were eligible and 22 (85%) accepted to participate in the trial and were randomized to the intervention (11; 50%) or control group (11; 50%). The median age of the include participants was 63 years. Adherence to the preoperative exercise sessions was 92.7%, with all participants either satisfied (33%) or extremely satisfied (67%) with the overall design of the preoperative exercise program. No significant differences in outcomes were found between groups.ConclusionsThe results of our pilot trial demonstrate that a preoperative exercise program is feasible and acceptable to patients undergoing major abdominal cancer surgery. There is an urgent need for a definite trial investigating the effectiveness of a preoperative exercise program on postoperative outcomes in patients undergoing major abdominal cancer surgery. This could potentially reduce postoperative complication rates, length of hospital stay and subsequently overall health care costs.Trial registrationACTRN12617001129370. Registered on August 1, 2017, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373396&showOriginal=true&isReview=true

Effect of Bilateral Ultrasound-Guided Quadratus Lumborum Block versus Lumbar Epidural Block on Postoperative Analgesia following Major Lower Abdominal Cancer Surgery

Background: Poor postoperative pain control leads to longer postoperative care, longer hospital stay and decreased patient overall satisfaction. Aim: To compare the efficacy and safety of bilateral ultrasound-guided quadratus lumborum block versus lumbar epidural block on the management of postoperative pain following major lower abdominal cancer surgery. Methods: The study was a double-blinded, and randomized study, conducted in South Egypt Cancer Institute, Assiut University, Egypt. It included cancer patients scheduled for major lower abdominal cancer surgery in the period from 2019 to 2020. They were divided into two groups: Group Ι received pre-emptive ultrasound-guided Quadratus Lumborum Block (QLB) with 25 mL of 0.25% bupivacaine on each side of the abdominal wall before induction of General Anesthesia (GA), and Group II received pre-emptive lumbar epidural block with 15 mL of 0.25% bupivacaine before induction of GA. VAS score, and time of the first analgesic request and postoperative total analgesic consumption were evaluated. Results: Sixty patients were included in our study. VAS score at rest was comparable between both studied groups in the first 6 h. At 8 and 10 h, Group II had a significantly higher VAS score at rest (P Limitation: Small sample size and shorter period for postoperative follow-up. Conclusions: Management of postoperative pain following major lower abdominal cancer surgery with US-guided QLB was associated with the reduction in the total analgesic consumption and delayed the first request of analgesia as compared to lumbar epidural block technique.

Risk factors of elderly patients with postoperative delirium following major abdominal surgery for cancer.

Postoperative delirium (POD) is a common complication in elderly patients after major abdominal surgery for cancer. Although POD is related with a poor outcome, there have not been many reports about POD after abdominal surgery in Korea. The aims of study were to analyze the characteristics and surgical outcomes of elderly patients with POD and to identify the risk factors of POD. From November 2016 to January 2019, we prospectively enrolled 63 patients who were aged ≥75 years and underwent major abdominal surgery for cancer. POD was daily assessed for up to 10 days postoperatively with the Confusion Assessment Method and a validated chart review. POD occurred in eight patients (12.7%). Univariate analysis showed that the occurrence of POD was related to sodium <135 mEq/L (P=0.037), combined resection (P=0.023), longer surgery/anesthesia time (P=0.023 and P=0.037, respectively), increased blood loss (P=0.004), postoperative admission to intensive care unit (ICU) (P=0.023), and duration of Foley catheter (P=0.011), however, multivariate analysis identified no significant risk factors of POD. There was no difference in postoperative outcomes such as hospital stay, mortality, reoperation, and morbidity between patients with POD and without POD. Elderly patients with hyponatremia, combined resection, longer operation/anesthesia time and admission to ICU had tendencies to develop POD after major abdominal surgery. Surgeons should pay more attention to prevent POD, and a large-scale prospective study is needed to identify the risk factors of POD.

Continuous peripheral perfusion index in patients admitted to hospital wards - An observational study.

Risk patients admitted to hospital wards may quickly develop haemodynamic deterioration and early recognition has high priority to allow preventive intervention. The peripheral perfusion index (PPI) may be an indicator of circulatory distress by assessing peripheral perfusion non-invasively from photoplethysmography. We aimed to describe the characteristics of PPI in hospitalized patients since this is not well-studied. Patients admitted due to either acute exacerbation of chronic obstructive pulmonary disease (AECOPD) or after major abdominal cancer surgery were included in this study. Patients were monitored continuously up to 96hours with a pulse oximeter. Comparisons between median PPI each day, time of day and admission type were described with mean difference (MD) and were analysed using Wilcoxon rank sum test and related to morbidity and mortality. PPI data from 291 patients were recorded for a total of 9279hours. Median PPI fell from 1.4 (inter quartile range, IQR 0.9-2.3) on day 1 to 1.0 (IQR 0.6-1.6) on day 4. Significant differences occurred between PPI day vs evening (MD=0.18, 95% CI 0.16-0.20, P=.028), day vs night (MD=0.56, 95% CI 0.49-0.62, P<.0001) and evening vs night (MD=0.38, 95% CI 0.33-0.42, P=.002). No significant difference in median PPI between AECOPD and surgical patients was found (MD=0.15, 95% CI -0.08-0.38, P=.62). Lower PPI during daytime vs evening and night-time were seen for both populations. The highest frequency of serious adverse events and mortality was seen among patients with low median PPI. The clinical impact of PPI monitoring needs further confirmation.

Cardiopulmonary Exercise Testing Versus Frailty, Measured by the Clinical Frailty Score, in Predicting Morbidity in Patients Undergoing Major Abdominal Cancer Surgery

The primary outcome of this study is to investigate the association between the cardiopulmonary exercise testing (CPET) variables: anaerobic threshold (AT), peak oxygen uptake (VO2 peak), peak work rate (WR), ventilatory equivalence of CO2 (VE/VCO2) at the anaerobic threshold (AT) with frailty, measured by the clinical frailty scale (CFS) in patients planned to undergo major abdominal cancer surgery. The secondary outcome is to compare the CPET variables (VO2 peak, peak WR, VE/VCO2 at AT) with frailty measured by the CFS in predicting postoperative surgical morbidity in patients following major abdominal cancer surgery. This study was a single-centre prospective cohort analysis of consecutive adult patients undergoing CPET and CFS scoring as part of their pre-operative work-up for major abdominal cancer surgery. A total of n = 317 patients underwent CPET and CFS assessment ahead of planned abdominal oncological surgery. Negative correlations were observed between the CPET variables: AT - 0.42 p < 0.01; VO2 peak - 0.53 p < 0.01; peak WR - 0.54 p < 0.01 with CFS scores and a positive correlation betweenCFS scoresand VE/VCO2 0.29 p < 0.01. Only CFS remained statistically significant in a multivariate model OR 2.11 (1.42-3.15) 95% CI associated with Clavien-Dindo (CD) ≥ 1 defined morbidity including the significant univariate variables (VO2 peak, peak WR and CFS scores). No variables were associated with CD ≥ 3 morbidity. In patients scheduled to have major abdominal cancer surgery there was a weak association between poor performance on CPET and increasing frailty measured by the CFS. The CFS score unlike CPET was associated with all post-operative morbidity, but not major complications alone, in these patients. This suggests that CFS may be used as a less expensive alternative to CPET for predicting any postoperative morbidity in major abdominal cancer surgery.

The Impact Of Sports Science-based Prehabilitation On Spontaneous Physical Activity After Major Abdominal Cancer Surgery

Complex surgery for abdominal cancer often leads to postoperative complications that may prevent post-surgical rehabilitation in old, frail, or malnourished patients. Prehabilitation is an emerging alternative strategy that has the potential to speed recovery and may be analogous to athletic preparations for gameday. For optimal physiological improvement to occur in a limited time period prior to the surgery, cancer patients undergoing prehabilitation interventions must work closer to their maximal physiological capacity (albeit a very low level) in a manner similar to that of competitive athletes. PURPOSE: To determine the effect of a 4-week sports science-based prehabilitation program on spontaneous physical activity in cancer patients who undergo major abdominal surgery. METHODS: Twenty-two cancer patients (63±11 years) who underwent major abdominal surgery were studied. Fourteen patients participated in a 4-week exercise and nutrition prehabilitation program prior to abdominal surgery. The sport-science based program comprised of an interdisciplinary approach, including blood flow restriction exercise and a daily sports nutrition supplement containing L-citrulline, creatine monohydrate, and whey protein. The remaining 8 patients served as controls. Physical activity of both groups was monitored for 5 days after surgery. Accelerometers were used to quantify number of steps, energy expenditure, and sedentary time. RESULTS: The prehabilitation group recorded 47.4% more total steps for 5 days after abdominal surgery than the control group (16,032±5,194 vs.10,877±5,182 total steps/5 days, p=0.037). The prehabilitation group had a greater amount of total energy expenditure than the control group (5,555±3,400 vs. 2,971±1,572 total kcal/5 days, p=0.028). There was no significant difference in total sedentary time between the two groups (5,064±597 vs. 5,414±514 min/5 days). CONCLUSIONS: This prehabilitation program composed of cutting-edge sports science practices significantly improved spontaneous physical activity after major surgery in older patients with abdominal cancers.