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Published in: BMC Gastroenterology 1/2023

Open Access 01-12-2023 | Colectomy | Research

Postoperative inpatient exercise facilitates recovery after laparoscopic surgery in colorectal cancer patients: a randomized controlled trial

Authors: Jihee Min, Ki-yong An, Hyuna Park, Wonhee Cho, Hye Jeong Jung, Sang Hui Chu, Minsoo Cho, Seung Yoon Yang, Justin Y. Jeon, Nam Kyu Kim

Published in: BMC Gastroenterology | Issue 1/2023

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Abstract

Background

Early mobilization is an integral part of an enhanced recovery program after colorectal cancer surgery. The safety and efficacy of postoperative inpatient exercise are not well known. The primary objective was to determine the efficacy of a postoperative exercise program on postsurgical recovery of stage I–III colorectal cancer patients.

Methods

We randomly allocated participants to postoperative exercise or usual care (1:1 ratio). The postoperative exercise intervention consisted of 15 min of supervised exercise two times per day for the duration of their hospital stay. The primary outcome was the length of stay (LOS) at the tertiary care center. Secondary outcomes included patient-perceived readiness for hospital discharge, anthropometrics (e.g., muscle mass), and physical function (e.g., balance, strength).

Results

A total of 52 (83%) participants (mean [SD] age, 56.6 [8.9] years; 23 [44%] male) completed the trial. The median LOS was 6.0 days (interquartile range; IQR 5–7 days) in the exercise group and 6.5 days (IQR 6–7 days) in the usual-care group (P = 0.021). The exercise group met the targeted LOS 64% of the time, while 36% of the usual care group met the targeted LOS (colon cancer, 5 days; rectal cancer, 7 days). Participants in the exercise group felt greater readiness for discharge from the hospital than those in the usual care group (Adjusted group difference = 14.4; 95% CI, 6.2 to 22.6; P < 0.01). We observed a small but statistically significant increase in muscle mass in the exercise group compared to usual care (Adjusted group difference = 0.63 kg; 95% CI, 0.16 to 1.1; P = 0.03).

Conclusion

Postsurgical inpatient exercise may promote faster recovery and discharge after curative-intent colorectal cancer surgery.

Trial registration

The study was registered at WHO International Clinical Trials Registry Platform (ICTRP; URL http://​apps.​who.​int/​trialsearch); Trial number: KCT0003920.
Appendix
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Literature
1.
go back to reference Keum N, Giovannucci E. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol. 2019;16(12):713–32.CrossRefPubMed Keum N, Giovannucci E. Global burden of colorectal cancer: emerging trends, risk factors and prevention strategies. Nat Rev Gastroenterol Hepatol. 2019;16(12):713–32.CrossRefPubMed
2.
go back to reference Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Stamos MJ, et al. Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. Am J Surg. 2012;204(6):952–7.CrossRefPubMed Kang CY, Chaudhry OO, Halabi WJ, Nguyen V, Carmichael JC, Stamos MJ, et al. Outcomes of laparoscopic colorectal surgery: data from the Nationwide Inpatient Sample 2009. Am J Surg. 2012;204(6):952–7.CrossRefPubMed
3.
go back to reference Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, McMurry TL, et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg. 2015;220(4):430–43.CrossRefPubMed Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, McMurry TL, et al. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg. 2015;220(4):430–43.CrossRefPubMed
4.
go back to reference Cianchi F, Trallori G, Mallardi B, Macri G, Biagini MR, Lami G, et al. Survival after laparoscopic and open surgery for colon cancer: a comparative, single-institution study. BMC Surg. 2015;15:33.CrossRefPubMedPubMedCentral Cianchi F, Trallori G, Mallardi B, Macri G, Biagini MR, Lami G, et al. Survival after laparoscopic and open surgery for colon cancer: a comparative, single-institution study. BMC Surg. 2015;15:33.CrossRefPubMedPubMedCentral
5.
go back to reference Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, et al. Clinical practice guidelines for enhanced recovery after Colon and rectal surgery from the american society of Colon and rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum. 2017;60(8):761–84.CrossRefPubMed Carmichael JC, Keller DS, Baldini G, Bordeianou L, Weiss E, Lee L, et al. Clinical practice guidelines for enhanced recovery after Colon and rectal surgery from the american society of Colon and rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons. Dis Colon Rectum. 2017;60(8):761–84.CrossRefPubMed
6.
go back to reference Wang LH, Zhu RF, Gao C, Wang SL, Shen LZ. Application of enhanced recovery after gastric cancer surgery: an updated meta-analysis. World J Gastroenterol. 2018;24(14):1562–78.CrossRefPubMedPubMedCentral Wang LH, Zhu RF, Gao C, Wang SL, Shen LZ. Application of enhanced recovery after gastric cancer surgery: an updated meta-analysis. World J Gastroenterol. 2018;24(14):1562–78.CrossRefPubMedPubMedCentral
7.
go back to reference Geltzeiler CB, Rotramel A, Wilson C, Deng L, Whiteford MH, Frankhouse J. Prospective study of colorectal enhanced recovery after surgery in a community hospital.JAMA Surg. Geltzeiler CB, Rotramel A, Wilson C, Deng L, Whiteford MH, Frankhouse J. Prospective study of colorectal enhanced recovery after surgery in a community hospital.JAMA Surg.
8.
go back to reference Currie AC, Malietzis G, Jenkins JT, Yamada T, Ashrafian H, Athanasiou T, et al. Network meta-analysis of protocol-driven care and laparoscopic surgery for colorectal cancer. Br J Surg. 2016;103(13):1783–94.CrossRefPubMed Currie AC, Malietzis G, Jenkins JT, Yamada T, Ashrafian H, Athanasiou T, et al. Network meta-analysis of protocol-driven care and laparoscopic surgery for colorectal cancer. Br J Surg. 2016;103(13):1783–94.CrossRefPubMed
9.
go back to reference Benbouzid A, Tabchouri N, Denet C, Ferraz JM, Laforest A, Gayet B, et al. Enhanced recovery protocols in colonic surgery: retrospective cohort analysis of economic impact from an institutional point of view. Int J Colorectal Dis. 2019;34(2):301–7.CrossRefPubMed Benbouzid A, Tabchouri N, Denet C, Ferraz JM, Laforest A, Gayet B, et al. Enhanced recovery protocols in colonic surgery: retrospective cohort analysis of economic impact from an institutional point of view. Int J Colorectal Dis. 2019;34(2):301–7.CrossRefPubMed
11.
go back to reference Laforest A, Bretagnol F, Mouazan AS, Maggiori L, Ferron M, Panis Y. Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life? Colorectal Dis. 2012;14(10):1231–7.CrossRefPubMed Laforest A, Bretagnol F, Mouazan AS, Maggiori L, Ferron M, Panis Y. Functional disorders after rectal cancer resection: does a rehabilitation programme improve anal continence and quality of life? Colorectal Dis. 2012;14(10):1231–7.CrossRefPubMed
12.
go back to reference Castelino T, Fiore JF Jr, Niculiseanu P, Landry T, Augustin B, Feldman LS. The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: a systematic review. Surgery. 2016;159(4):991–1003.CrossRefPubMed Castelino T, Fiore JF Jr, Niculiseanu P, Landry T, Augustin B, Feldman LS. The effect of early mobilization protocols on postoperative outcomes following abdominal and thoracic surgery: a systematic review. Surgery. 2016;159(4):991–1003.CrossRefPubMed
13.
go back to reference Fiore JF Jr, Castelino T, Pecorelli N, Niculiseanu P, Balvardi S, Hershorn O, et al. Ensuring early mobilization within an enhanced recovery program for colorectal surgery: a Randomized Controlled Trial. Ann Surg. 2017;266(2):223–31.CrossRefPubMed Fiore JF Jr, Castelino T, Pecorelli N, Niculiseanu P, Balvardi S, Hershorn O, et al. Ensuring early mobilization within an enhanced recovery program for colorectal surgery: a Randomized Controlled Trial. Ann Surg. 2017;266(2):223–31.CrossRefPubMed
14.
go back to reference Balvardi S, Pecorelli N, Castelino T, Niculiseanu P, Alhashemi M, Liberman AS, et al. Impact of facilitation of early mobilization on postoperative pulmonary outcomes after colorectal surgery: a Randomized Controlled Trial. Ann Surg. 2021;273(5):868–75.CrossRefPubMed Balvardi S, Pecorelli N, Castelino T, Niculiseanu P, Alhashemi M, Liberman AS, et al. Impact of facilitation of early mobilization on postoperative pulmonary outcomes after colorectal surgery: a Randomized Controlled Trial. Ann Surg. 2021;273(5):868–75.CrossRefPubMed
15.
go back to reference Raue W, Haase O, Junghans T, Scharfenberg M, Muller JM, Schwenk W. Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation. Surg Endosc. 2004;18(10):1463–8.CrossRefPubMed Raue W, Haase O, Junghans T, Scharfenberg M, Muller JM, Schwenk W. Fast-track’ multimodal rehabilitation program improves outcome after laparoscopic sigmoidectomy: a controlled prospective evaluation. Surg Endosc. 2004;18(10):1463–8.CrossRefPubMed
16.
go back to reference Lee TG, Kang SB, Kim DW, Hong S, Heo SC, Park KJ. Comparison of early mobilization and diet rehabilitation program with conventional care after laparoscopic colon surgery: a prospective randomized controlled trial. Dis Colon Rectum. 2011;54(1):21–8.CrossRefPubMed Lee TG, Kang SB, Kim DW, Hong S, Heo SC, Park KJ. Comparison of early mobilization and diet rehabilitation program with conventional care after laparoscopic colon surgery: a prospective randomized controlled trial. Dis Colon Rectum. 2011;54(1):21–8.CrossRefPubMed
17.
go back to reference Le H, Khankhanian P, Joshi N, Maa J, Crevensten H. Patients recovering from abdominal surgery who walked with volunteers had improved postoperative recovery profiles during their hospitalization. World J Surg. 2014;38(8):1961–5.CrossRefPubMed Le H, Khankhanian P, Joshi N, Maa J, Crevensten H. Patients recovering from abdominal surgery who walked with volunteers had improved postoperative recovery profiles during their hospitalization. World J Surg. 2014;38(8):1961–5.CrossRefPubMed
18.
go back to reference Liebermann M, Awad M, Dejong M, Rivard C, Sinacore J, Brubaker L. Ambulation of hospitalized gynecologic surgical patients: a randomized controlled trial. Obstet Gynecol. 2013;121(3):533–7.CrossRefPubMed Liebermann M, Awad M, Dejong M, Rivard C, Sinacore J, Brubaker L. Ambulation of hospitalized gynecologic surgical patients: a randomized controlled trial. Obstet Gynecol. 2013;121(3):533–7.CrossRefPubMed
19.
go back to reference Ahn KY, Hur H, Kim DH, Min J, Jeong DH, Chu SH, et al. The effects of inpatient exercise therapy on the length of hospital stay in stages I-III colon cancer patients: randomized controlled trial. Int J Colorectal Dis. 2013;28(5):643–51.CrossRefPubMed Ahn KY, Hur H, Kim DH, Min J, Jeong DH, Chu SH, et al. The effects of inpatient exercise therapy on the length of hospital stay in stages I-III colon cancer patients: randomized controlled trial. Int J Colorectal Dis. 2013;28(5):643–51.CrossRefPubMed
20.
go back to reference Weiss ME, Piacentine LB, Lokken L, Ancona J, Archer J, Gresser S, et al. Perceived readiness for hospital discharge in adult medical-surgical patients. Clin Nurse Spec. 2007;21(1):31–42.CrossRefPubMed Weiss ME, Piacentine LB, Lokken L, Ancona J, Archer J, Gresser S, et al. Perceived readiness for hospital discharge in adult medical-surgical patients. Clin Nurse Spec. 2007;21(1):31–42.CrossRefPubMed
21.
go back to reference Weiss ME, Piacentine LB. Psychometric properties of the readiness for Hospital Discharge Scale. J Nurs Meas. 2006;14(3):163–80.CrossRefPubMed Weiss ME, Piacentine LB. Psychometric properties of the readiness for Hospital Discharge Scale. J Nurs Meas. 2006;14(3):163–80.CrossRefPubMed
23.
24.
go back to reference Lin TH. A comparison of multiple imputation with EM algorithm and MCMC method for quality of life missing data. Qual Quant. 2010;44(2):277–87.CrossRef Lin TH. A comparison of multiple imputation with EM algorithm and MCMC method for quality of life missing data. Qual Quant. 2010;44(2):277–87.CrossRef
25.
go back to reference Ni X, Jia D, Chen Y, Wang L, Suo J. Is the enhanced recovery after surgery (ERAS) program effective and safe in laparoscopic colorectal Cancer surgery? A Meta-analysis of Randomized controlled trials. J Gastrointest Surg. 2019;23(7):1502–12.CrossRefPubMed Ni X, Jia D, Chen Y, Wang L, Suo J. Is the enhanced recovery after surgery (ERAS) program effective and safe in laparoscopic colorectal Cancer surgery? A Meta-analysis of Randomized controlled trials. J Gastrointest Surg. 2019;23(7):1502–12.CrossRefPubMed
26.
go back to reference Francis NK, Mason J, Salib E, Allanby L, Messenger D, Allison AS, et al. Factors predicting 30-day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery programme. Colorectal Dis. 2015;17(7):O148–54.CrossRefPubMed Francis NK, Mason J, Salib E, Allanby L, Messenger D, Allison AS, et al. Factors predicting 30-day readmission after laparoscopic colorectal cancer surgery within an enhanced recovery programme. Colorectal Dis. 2015;17(7):O148–54.CrossRefPubMed
27.
go back to reference Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006;93(7):800–9.CrossRefPubMed Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, et al. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006;93(7):800–9.CrossRefPubMed
28.
go back to reference Schneider EB, Hyder O, Brooke BS, Efron J, Cameron JL, Edil BH et al. Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors. J Am Coll Surg. 2012;214(4):390-8; discussion 8–9. Schneider EB, Hyder O, Brooke BS, Efron J, Cameron JL, Edil BH et al. Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors. J Am Coll Surg. 2012;214(4):390-8; discussion 8–9.
29.
go back to reference Hoplock L, Lobchuk M, Dryburgh L, Shead N, Ahmed R. Canadian hospital and home visiting nurses’ attitudes toward families in Transitional Care: a descriptive comparative study. J Fam Nurs. 2019;25(3):370–94.CrossRefPubMed Hoplock L, Lobchuk M, Dryburgh L, Shead N, Ahmed R. Canadian hospital and home visiting nurses’ attitudes toward families in Transitional Care: a descriptive comparative study. J Fam Nurs. 2019;25(3):370–94.CrossRefPubMed
30.
go back to reference Federman AD, Soones T, DeCherrie LV, Leff B, Siu AL. Association of a Bundled Hospital-at-home and 30-Day postacute Transitional Care Program with Clinical Outcomes and patient experiences. JAMA Intern Med. 2018;178(8):1033–40.CrossRefPubMedPubMedCentral Federman AD, Soones T, DeCherrie LV, Leff B, Siu AL. Association of a Bundled Hospital-at-home and 30-Day postacute Transitional Care Program with Clinical Outcomes and patient experiences. JAMA Intern Med. 2018;178(8):1033–40.CrossRefPubMedPubMedCentral
31.
go back to reference Shida D, Tagawa K, Inada K, Nasu K, Seyama Y, Maeshiro T, et al. Enhanced recovery after surgery (ERAS) protocols for colorectal cancer in Japan. BMC Surg. 2015;15:90.CrossRefPubMedPubMedCentral Shida D, Tagawa K, Inada K, Nasu K, Seyama Y, Maeshiro T, et al. Enhanced recovery after surgery (ERAS) protocols for colorectal cancer in Japan. BMC Surg. 2015;15:90.CrossRefPubMedPubMedCentral
32.
go back to reference Kim JY, Wie GA, Cho YA, Kim SY, Sohn DK, Kim SK, et al. Diet Modification based on the enhanced recovery after surgery program (ERAS) in patients undergoing laparoscopic colorectal resection. Clin Nutr Res. 2018;7(4):297–302.CrossRefPubMedPubMedCentral Kim JY, Wie GA, Cho YA, Kim SY, Sohn DK, Kim SK, et al. Diet Modification based on the enhanced recovery after surgery program (ERAS) in patients undergoing laparoscopic colorectal resection. Clin Nutr Res. 2018;7(4):297–302.CrossRefPubMedPubMedCentral
33.
go back to reference Pisarska M, Pędziwiatr M, Małczak P, Major P, Ochenduszko S, Zub-Pokrowiecka A, et al. Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study. Int J Surg. 2016;36:377–82.CrossRefPubMed Pisarska M, Pędziwiatr M, Małczak P, Major P, Ochenduszko S, Zub-Pokrowiecka A, et al. Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study. Int J Surg. 2016;36:377–82.CrossRefPubMed
34.
go back to reference Scioscia M, Ceccaroni M, Gentile I, Rossini R, Clarizia R, Brunelli D, et al. Randomized trial on fast track care in colorectal surgery for deep infiltrating endometriosis. J Minim Invasive Gynecol. 2017;24(5):815–21.CrossRefPubMed Scioscia M, Ceccaroni M, Gentile I, Rossini R, Clarizia R, Brunelli D, et al. Randomized trial on fast track care in colorectal surgery for deep infiltrating endometriosis. J Minim Invasive Gynecol. 2017;24(5):815–21.CrossRefPubMed
35.
go back to reference Onerup A, Andersson J, Angenete E, Bock D, Borjesson M, Ehrencrona C, et al. Effect of short-term Homebased pre- and postoperative Exercise on Recovery after Colorectal Cancer surgery (PHYSSURG-C): a Randomized Clinical Trial. Ann Surg. 2022;275(3):448–55.CrossRefPubMed Onerup A, Andersson J, Angenete E, Bock D, Borjesson M, Ehrencrona C, et al. Effect of short-term Homebased pre- and postoperative Exercise on Recovery after Colorectal Cancer surgery (PHYSSURG-C): a Randomized Clinical Trial. Ann Surg. 2022;275(3):448–55.CrossRefPubMed
Metadata
Title
Postoperative inpatient exercise facilitates recovery after laparoscopic surgery in colorectal cancer patients: a randomized controlled trial
Authors
Jihee Min
Ki-yong An
Hyuna Park
Wonhee Cho
Hye Jeong Jung
Sang Hui Chu
Minsoo Cho
Seung Yoon Yang
Justin Y. Jeon
Nam Kyu Kim
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2023
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-023-02755-x

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