The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients. ARTICLE in EUROPEAN JOURNAL OF SURGICAL ONCOLOGY: THE JOURNAL OF THE EUROPEAN SOCIETY OF SURGICAL ONCOLOGY AND THE BRITISH ASSOCIATION OF SURGICAL ONCOLOGY

Background: Neoadjuvant chemoradiotherapy (NACRT) followed by surgery for resectable locally advanced rectal cancer improves outcome compared with surgery alone. Our primary hypothesis was that NACRT impairs objectively-measured physical fitness. We also wished to explore the relationship between fitness and postoperative outcome. Method: In an observational study, we prospectively studied 27 consecutive patients, of whom 25 undertook cardiopulmonary exercise testing (CPET) 2 weeks before and 7 weeks after standardized NACRT, then underwent surgery. In-hospital post-operative morbidity and mortality were recorded. Patients were followed up to 1 year for mortality. Data was analysed blind to clinical details. Receiver-operating characteristic (ROC) analysis defined the predictive value of CPET for in-hospital morbidity at day 5. Results: Oxygen uptake ( _ VO2 in ml kg 1 min ) at estimated lactate threshold ðbqLÞ and at peak exercise ( _ VO2 at peak in ml kg 1 min ) both significantly decreased post-NACRT: _ VO2 at bqL 12.1 (pre-NACRT) vs. 10.6 (post-NACRT), p < 0.001 (95%CI 1.7, 1.2); _ VO2 at peak 18.1 vs. 16.7, p < 0.001 (95%CI 3.1, 1.0). Optimal _ VO2 at bqL and peak pre-NACRT for predicting postoperative morbidity were 12.0 and 18.1 ( _ VO2 at bqL e AUC 1⁄4 0.71, 77% sensitive and 75% specific; _ VO2 at peak e AUC 1⁄4 0.75, 78% sensitive and 76% specific). Optimal _ VO2 at bqL and peak post-NACRT for predicting postoperative morbidity were 10.7 and 16.7 ( _ VO2 at bqL e AUC 1⁄4 0.72, 77% sensitive and 83% specific; _ VO2 at peak e AUC 1⁄4 0.80, 85% sensitive and 83% specific). Conclusion: NACRT before major rectal cancer surgery significantly decreased physical fitness as assessed by CPET. Trials Registry Number: NCT01334593. 2014 Elsevier Ltd. All rights reserved.