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Multimodal Prehabilitation for Colorectal Surgery

ABSTRACT: Despite advances in surgical care, the incidence of postoperative complications and prolonged recovery following colorectal surgery remains high. Efforts to improve the recovery process have primarily focused on the intraoperative (eg, minimally invasive surgery, afferent neural blockade) and post-operative periods (eg, "fast track" early nutrition and mobilization. The pre-operative period may in fact be a better time to intervene in the factors that contribute to recovery. The process of enhancing functional capacity of the individual in anticipation of an upcoming stressor has been termed "prehabilitation". Based on the notion that preoperative exercise would have an impact on recovery of functional capacity after colorectal surgery, our group recently conducted a randomized controlled trial. Subgroup analysis identified that patients whose functional exercise capacity improved preoperatively, regardless of exercise technique, recovered well in the postoperative period. However, one-third of patients deteriorated preoperatively despite the exercise regimen, and these patients were also at greater risk for prolonged recovery after surgery. These results suggested that exercise alone is not sufficient to attenuate the stress response in all patients. In the present trial, the impact of a multimodal prehabilitation intervention composed of exercise, nutritional supplement and psychological well-being begun in the preoperative period will be compared to one begun in the postoperative period.

DISEASE(S): Colorectal Cancer,Colorectal Neoplasms,Colorectal Cancer Stage Iii

PROVIDER: 2106864 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:MiRNAs are essential mediators of many biological processes. The aim of this study was to investigate the dynamics of miRNA-mRNA regulatory networks during exercise and subsequent recovery period. Here we monitored the transcriptome changes by microarray analysis of the whole blood of eight highly trained athletes after 30 min of moderate exercise followed by 30 min and 60 min of recovery period. We combined expression profiling and bioinformatics and analysed metabolic pathways enriched with differentially expressed mRNAs and then mRNAs which are known to be validated targets of differentially expressed miRNAs. Finally we revealed four dynamically regulated networks comprising differentially expressed miRNAs and their known target mRNAs with anti-correlated expression profiles over time. The data suggest that hsa-miR-21-5p regulated TGFBR3, PDGFD and PPM1L mRNAs. Hsa-miR-24-2-5p was likely to be responsible for MYC and KCNJ2 genes and hsa-miR-27a-5p for ST3GAL6. The targets of hsa-miR-181a-5p included ROPN1L and SLC37A3. All these mRNAs are involved in processes highly relevant to exercise response, including immune function, apoptosis, membrane traffic of proteins and transcription regulation. We have identified four miRNA-mRNA networks dynamically regulated following exercise. This work is the first study to monitor miRNAs and mRNAs in parallel into recovery period. The results provide a novel insight into the regulatory role of miRNAs in stress adaptation. Each subject performed a treadmill test with an incremental step protocol until exhaustion. Blood samples were taken from the antecubital vein using indwelling catheter before (T1), immediately after ramp test to exaustion (T2) and after 30 min of recovery (T3). Two weeks later, athletes participated in the main exercise, consisting of running at 80% VO2 peak for 30 min on a treadmill. Blood samples were taken from the antecubital vein using indwelling catheter before (T4), immediately after running at 80% VO2 peak for 30 min on a treadmill (T5), after 30 min (T6) and 60 min (T7) of recovery.

Project description:Interventions: Study setting- The study will be conducted at the Surgical Professorial Unit of Colombo South Teaching Hospital. Method of randomization- • Following consent, participants will be randomized 1:1 using a random number table to the intervention group or control group with stratification by gender and age group. •The research associate (who will be responsible for patient consent) will be blinded to group allocation. Description of mindfulness based tromodal prehabilitation intervention • The multidisciplinary Mindfulnes-Based trimodal prehabilitation program is composed of four (04) elements: 1. Exercise program 2. Nutritional intervention 3. Psychological coping 4. Mindfulness Protocol • The exact interventions are described in detail below: Exercise program • Patients will be asked to perform unsupervised exercises 4 days a week for 30 minutes per session. • The exercise regime will comprise of 5 min warm-up exercises, 20 min aerobic exercises and 5 min cool down exercises. • A personalized trainer will evaluate the patient and after discussing with the patient and their families will come up with an individualized exercise plan for the patients based on their physical capacity and resources. • They will also be given a DVD containing videos of the exercises performed by a trained personal giving instruction to the patient to follow. • Patients will be given a chart to fill once completing their exercise regime daily. Nutrition intervention • The patients enrolled in the prehabilitation program will be evaluated by a qualified nutritionist during the first visit, Aasubjective global assessment will be used to assess each patients’ nutritional status and requirements and an appropr Primary outcome(s): Functional recovery using the Six-Minute Walk Test (6MWT, Pulse Rate (PR), Blood Pressure (BP) and Oxygen Saturation (SpO2) [1. At the start of the trial 2. Four weeks after prehabilitation or Before the surgery 3. 4-Weeks post-operatively 4. 8-Weeks post-operatively ] Study Design: Randomized controlled trial

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Multimodal Prehabilitation for Colorectal Surgery

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