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Randomized clinical trial of prehabilitation before planned liver resection.
Br J Surg 2016; 103(5):504-12BJ

Abstract

BACKGROUND

Patients with low fitness as assessed by cardiopulmonary exercise testing (CPET) have higher mortality and morbidity after surgery. Preoperative exercise intervention, or prehabilitation, has been suggested as a method to improve CPET values and outcomes. This trial sought to assess the capacity of a 4-week supervised exercise programme to improve fitness before liver resection for colorectal liver metastasis.

METHODS

This was a randomized clinical trial assessing the effect of a 4-week (12 sessions) high-intensity cycle, interval training programme in patients undergoing elective liver resection for colorectal liver metastases. The primary endpoint was oxygen uptake at the anaerobic threshold. Secondary endpoints included other CPET values and preoperative quality of life (QoL) assessed using the SF-36®.

RESULTS

Thirty-eight patients were randomized (20 to prehabilitation, 18 to standard care), and 35 (25 men and 10 women) completed both preoperative assessments and were analysed. The median age was 62 (i.q.r. 54-69) years, and there were no differences in baseline characteristics between the two groups. Prehabilitation led to improvements in preoperative oxygen uptake at anaerobic threshold (+1·5 (95 per cent c.i. 0·2 to 2·9) ml per kg per min) and peak exercise (+2·0 (0·0 to 4·0) ml per kg per min). The oxygen pulse (oxygen uptake per heart beat) at the anaerobic threshold improved (+0·9 (0·0 to 1·8) ml/beat), and a higher peak work rate (+13 (4 to 22) W) was achieved. This was associated with improved preoperative QoL, with the overall SF-36® score increasing by 11 (95 per cent c.i. 1 to 21) (P = 0·028) and the overall SF-36® mental health score by 11 (1 to 22) (P = 0·037).

CONCLUSION

A 4-week prehabilitation programme can deliver improvements in CPET scores and QoL before liver resection. This may impact on perioperative outcome.

REGISTRATION NUMBER

NCT01523353 (https://clinicaltrials.gov).

Authors+Show Affiliations

Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK. Institute of Translational Medicine, University of Liverpool, Liverpool, UK.National Institute for Health Research Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK.Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK. Institute of Translational Medicine, University of Liverpool, Liverpool, UK.Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK.Cancer Research UK, Liverpool Cancer Trials Unit, Liverpool, UK.Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK.Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK.Institute of Translational Medicine, University of Liverpool, Liverpool, UK. Clatterbridge Cancer Centre, Wirral, UK.Liverpool Hepatobiliary Centre, Aintree University Hospital, Liverpool, UK.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26864728

Citation

Dunne, D F J., et al. "Randomized Clinical Trial of Prehabilitation Before Planned Liver Resection." The British Journal of Surgery, vol. 103, no. 5, 2016, pp. 504-12.
Dunne DF, Jack S, Jones RP, et al. Randomized clinical trial of prehabilitation before planned liver resection. Br J Surg. 2016;103(5):504-12.
Dunne, D. F., Jack, S., Jones, R. P., Jones, L., Lythgoe, D. T., Malik, H. Z., ... Fenwick, S. W. (2016). Randomized clinical trial of prehabilitation before planned liver resection. The British Journal of Surgery, 103(5), pp. 504-12. doi:10.1002/bjs.10096.
Dunne DF, et al. Randomized Clinical Trial of Prehabilitation Before Planned Liver Resection. Br J Surg. 2016;103(5):504-12. PubMed PMID: 26864728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized clinical trial of prehabilitation before planned liver resection. AU - Dunne,D F J, AU - Jack,S, AU - Jones,R P, AU - Jones,L, AU - Lythgoe,D T, AU - Malik,H Z, AU - Poston,G J, AU - Palmer,D H, AU - Fenwick,S W, Y1 - 2016/02/11/ PY - 2015/08/14/received PY - 2015/11/21/revised PY - 2015/12/01/accepted PY - 2016/2/12/entrez PY - 2016/2/13/pubmed PY - 2016/8/6/medline SP - 504 EP - 12 JF - The British journal of surgery JO - Br J Surg VL - 103 IS - 5 N2 - BACKGROUND: Patients with low fitness as assessed by cardiopulmonary exercise testing (CPET) have higher mortality and morbidity after surgery. Preoperative exercise intervention, or prehabilitation, has been suggested as a method to improve CPET values and outcomes. This trial sought to assess the capacity of a 4-week supervised exercise programme to improve fitness before liver resection for colorectal liver metastasis. METHODS: This was a randomized clinical trial assessing the effect of a 4-week (12 sessions) high-intensity cycle, interval training programme in patients undergoing elective liver resection for colorectal liver metastases. The primary endpoint was oxygen uptake at the anaerobic threshold. Secondary endpoints included other CPET values and preoperative quality of life (QoL) assessed using the SF-36®. RESULTS: Thirty-eight patients were randomized (20 to prehabilitation, 18 to standard care), and 35 (25 men and 10 women) completed both preoperative assessments and were analysed. The median age was 62 (i.q.r. 54-69) years, and there were no differences in baseline characteristics between the two groups. Prehabilitation led to improvements in preoperative oxygen uptake at anaerobic threshold (+1·5 (95 per cent c.i. 0·2 to 2·9) ml per kg per min) and peak exercise (+2·0 (0·0 to 4·0) ml per kg per min). The oxygen pulse (oxygen uptake per heart beat) at the anaerobic threshold improved (+0·9 (0·0 to 1·8) ml/beat), and a higher peak work rate (+13 (4 to 22) W) was achieved. This was associated with improved preoperative QoL, with the overall SF-36® score increasing by 11 (95 per cent c.i. 1 to 21) (P = 0·028) and the overall SF-36® mental health score by 11 (1 to 22) (P = 0·037). CONCLUSION: A 4-week prehabilitation programme can deliver improvements in CPET scores and QoL before liver resection. This may impact on perioperative outcome. REGISTRATION NUMBER: NCT01523353 (https://clinicaltrials.gov). SN - 1365-2168 UR - https://www.unboundmedicine.com/medline/citation/26864728/Randomized_clinical_trial_of_prehabilitation_before_planned_liver_resection_ L2 - https://doi.org/10.1002/bjs.10096 DB - PRIME DP - Unbound Medicine ER -