Abstract

Background: Rectal cancer treatment with neoadjuvant radiotherapy or chemoradiotherapy (NAT) prior to anaesthesia and surgery may reduce fitness and so increase perioperative risk. Understanding the mechanisms by which NAT reduces functional capacity will inform the development of preoperative risk reduction strategies such as prehabilitation. We hypothesized that the effects of NAT are mediated through the inflammatory response and changes in body composition with loss of muscle.

Objectives: The objectives of the study were to examine the associations between changes in functional reserve measured by cardiopulmonary exercise testing (CPET) and the inflammatory responses and changes in body composition produced by NAT.

Design: Prospective cohort study.

Setting: United Kingdom regional cancer centre.

Patients: Thirty-six patients (28 male) who received preoperative long course chemoradiotherapy (LCCR) n = 24, or short course radiotherapy (SCRT) n = 12 prior to rectal cancer surgery were studied. Patients unable to perform CPET were excluded.

Main Outcome Measures: Assessments were made before and within two weeks after NAT. Anaerobic threshold (AT) and peak oxygen consumption (VO₂peak) were measured by CPET. Body composition was assessed by bioelectrical impedance and blood samples taken for assay of cytokines and other inflammatory markers.

Results: LCCR patients had a significant decline in VO₂peak (p = 0.005) and reductions in several anthropometric variables (all p < 0.01) after NAT. SCRT patients had no significant changes in their functional capacity data but showed changes in a number of anthropometric variables (all p < 0.04) after NAT. Cytokines and inflammatory markers showed wide variability. There were no clinically important associations between changes in functional capacity and changes in either anthropomorphic variables or biomarkers.

Conclusion: Our data confirm the impact of NAT on fitness for surgery. They are not consistent with an association between the changes in functional capacity seen with preoperative NAT and either changes in body composition or the inflammatory response to preoperative cancer treatment.

Keywords: Neoadjuvant Therapy; Radiotherapy; Chemoradiotherapy

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Citation

Citation: Samir Rahmani., et al. “The Effect of Neo-adjuvant Cancer Therapy on Fitness for Anaesthesia and Surgery; A Prospective Cohort Study". Acta Scientific Medical Sciences 4.12 (2020): 53-63.

Copyright

Copyright: © 2020 Samir Rahmani., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.