Physical fitness and body composition assessments in advanced cancer patients undergoing exenterative surgery – A pilot cohort study

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Abstract Aim Locally advanced pelvic malignancies, such as colorectal and anal cancers, can only be cured through multimodal cancer treatment including multi‐visceral exenterative resections, which carry a high mortality and morbidity risk. Despite strong predictive abilities in other cancer cohorts, the combined prognostic value of body composition and cardiopulmonary exercise testing (CPET) for major in‐hospital morbidity in patients undergoing exenterative surgery for advanced pelvic cancers has not been evaluated. Method A locally advanced colorectal and anal cancer cohort was derived from a prospectively maintained quaternary database. CPET was undertaken preoperatively, according to national guidelines. Skeletal muscle index (SMI) and radiation attenuation (SM‐RA) were obtained from analysing L3 slices from preoperative computed tomography scans using SliceOmatic 5.0 and classified using predefined thresholds. Major morbidity was defined as Clavien‐Dindo classification 3a or greater. Results From 247 patients (58% male, median age 60 years), 62.4% and 35.5% had locally advanced or recurrent disease respectively. Physical fitness variables were significantly reduced in low SMI or low SM‐RA patients. In multivariate linear regression, SMI was strongly predictive of oxygen uptake at the anaerobic threshold (B = 0.013, p = 0.001) and at peak (B = 0.015, p = 0.002). 17.3% of all patients experienced a major postoperative complication. In multivariate analysis, reduced peak power output (<1.5 W kg −1 ) was significantly associated with an increased risk of postoperative major morbidity (OR = 2.6, p = 0.012). Conclusion CPET may be predictive of in‐hospital major morbidity in this cohort. The association of CPET with body composition necessitates further evaluation and external validation in a larger patient cohort, specifically interrogating their combined role in morbidity prediction and as a target for prehabilitation interventions.

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