Does pre-surgery chemoradiotherapy reduce physical fitness and leave patients at risk of surgical complications?

This study investigated the impact of pre-surgery chemoradiotherapy on physical fitness for patients with rectal cancer. They also explored whether physical fitness affects recovery from surgery.

Locally advanced rectal cancer indicates that the cancer has spread beyond the lining of the rectum or has spread to the nearby lymph nodes. About 25% of patients are diagnosed with having locally advanced rectal cancer. These patients often receive neoadjuvant chemoradiotherapy (chemotherapy plus radiotherapy given before surgery) as it is known to improve patient outcome.

Previous reports have suggested that fitness levels before surgery are the strongest predictor of death within 30 days of surgery. Cardiorespiratory (heart and lung) fitness reliably predicts outcomes following major surgery. Therefore, understanding how cancer or cancer therapies affect cardiorespiratory fitness is important for ensuring the best possible surgical care.

This study included 25 patients with locally advanced rectal cancer. Each patients’ physical fitness was assessed twice using a cardiopulmonary exercise test (measures the impact of exercise on heart and lung function). Patients were tested at rest and after exercising 2 weeks before and 7 weeks after neoadjuvant chemoradiotherapy.

Neoadjuvant therapy decreased physical fitness. The average level of oxygen uptake (higher uptake levels indicate better aerobic fitness) was decreased both at rest (decreased from 12.1 ml kg^-1 min^-1 to 10.6 ml kg^-1 min^-1) and following exercise (decreased from 18.1 ml kg^-1 min^-1 to 16.7 ml kg^-1 min^-1). Average patient heart rate was not affected by neoadjuvant therapy.

The odds of patients suffering from complications after surgery decreased by 90% if patients had resting oxygen uptake levels above 12.1 ml kg^-1 min^-1 before neoadjuvant therapy. The odds of patients suffering from complications also decreased by 90% if resting oxygen levels were above 10.7 ml kg^-1 min^-1 after neoadjuvant therapy. The odds of patients suffering from complications also decreased by 85% to 95% for patients with higher oxygen uptake following exercise: above 18.1 ml kg^-1 min^-1 before neoadjuvant therapy and above 16.7 ml kg^-1 min^-1 after neoadjuvant therapy.

The authors concluded that neoadjuvant chemotherapy decreased physical fitness in patients with rectal cancer. They suggest that pre-surgery exercise therapy might improve physical fitness and improve surgical outcome. 

This was a small study. Further research is required to ensure the reproducibility of these results.