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The effect of postsurgery execise on recovery from colorectal cancer surgery

ABSTRACT: Background and study aims A transient postoperative ileus, a temporary disturbance in gastric and bowel motility following surgery, is recognized as an expected outcome of any major abdominal surgery including colon and rectum. Delayed recovery from the surgery would also delay the initiation of subsequent therapies. Therefore, it is important to find modality which may reduce postoperative ileus and enhance recovery from the surgery as early as possible. In recent years, the Enhance Recovery after Surgery (ERAS) aimed at improving before and after surgery care and decreasing postoperative complication, has been used extensively. Techniques include optimal pain control by epidural (anaesthetic drug injected in spine) and local anaesthesia, minimally invasive techniques and aggressive post-operative rehabilitation, which include early feeding, removal of tube, early ambulation (walking). Although studies examined the safety, efficacy and effectiveness of this protocol on surgery outcomes including the length of hospital study, these studies did not measure the effects of early ambulation separately. Therefore, the purposes of the current study are 1) to investigate the effects of post-surgery exercise on surgery outcomes including the length of hospital stay, time to flatus (passing wind) and time to first normal diet, 2) to investigate the association between surgery outcomes change in body measurements and fitness levels during recovery from surgery. Who can participate? Patients who are admitted to Severance hospital for stage 1-3 colon cancer can participate in the study. To take part you need to be aged 18 years or older, have a good understanding of Korean language and is willing to participate in the study. What does the study involve? Patients will be randomly allocated to control group (usual care) or exercise group. In the exercise group patients will undergo 1-15 minute exercise under the guidance of exercise therapist. Fitness will be measured before the surgery and one day before the hospital release.

DISEASE(S): Stage I To Iii Colon Cancer

PROVIDER: 2419995 | ecrin-mdr-crc |

REPOSITORIES: ECRIN MDR

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Project description:Colorectal Surgery Preoperative Exercise Training is a study being run by the colorectal surgery team at the Norfolk and Norwich University Hospital and the University of East Anglia to look at the role of exercise before surgery to improve recovery following an operation. Having an operation to remove part of the bowel puts physical stress on the body. We know that training can help the body cope with physical stress in the same way that an athlete trains before a competition. We hypothesise that the body may recover more quickly if it is trained prior to an operation with regular and simple exercises. Cardiopulmonary exercise testing (CPET) is used to evaluate the function of the lungs, heart and muscles at rest and during exercise. CPET testing is often done as part of standard pre-operative assessment in many hospitals for patients before undergoing major surgery. Some studies have demonstrated that CPET can be used to predict outcomes following surgery (such as time taken till discharge, complication rates). The study consists of two parts: Study 1) CPET variables to predict outcomes in surgery - patients will undergo a CPET test to determine baseline fitness. Blood tests will be taken around the time of surgery to examine whether biochemical markers in the bloodstream (when used in combination with results from the CPET test) can predict outcomes and recovery following colorectal surgery. Patients will then be monitored to assess their speed of recovery and rate of complications following surgery. This will enable us to determine which CPET variables or combination of variables are most useful in the prediction of post-operative complications following colorectal surgery. 2) The second study will consist of an exercise intervention involving several sessions of supervised exercise in a laboratory. Before and at the end the exercise training regime, CPET measurements will be taken to see if fitness has improved with exercise. This part of of the study is to determine if it is feasible to implement a structured, supervised exercise programme for patients awaiting elective colorectal cancer surgery. The results of this study will be used to inform a larger randomised controlled trial to examine the influence of exercise on CPET variables and postoperative outcomes.

Project description:Background: Current studies provide compelling evidence that the enteric nervous system and neighboring resident macrophages in the muscularis externa modulate neuroimmune processes in the gut after abdominal surgery. While substantial knowledge exists about macrophage-enteric glia interactions, the fate of enteric neurons, which have an indispensable role in gut homeostasis and gastrointestinal motility, has not been thoroughly investigated during enteric neuroinflammation. Therefore, we investigated the impact of enteric neuron-macrophage interactions on postoperative trauma and subsequent motility disturbances, i.e., postoperative ileus. Methods: Neuroinflammation and postoperative ileus were induced in various transgenic mice by surgical manipulation of the small intestine. We studied enteric neurons and macrophage-specific transcriptomes using bulk RNA-Seq in neuron-specific RiboTag mice and sorted CX3CR1-GFP+ macrophages. To investigate their intercellular communication, we treated CX3CR1-GFP+ mice with CSFR1-antibody to deplete macrophages and subsequently induce POI through surgical trauma. These mice were examined for gastrointestinal motility, immune cell infiltration, and neuronal function. Ultimately, we validated the murine data in human gut samples collected early and late during abdominal surgery to understand the impact of surgical manipulation on patients' enteric nervous system function. Results: We detected strong neuronal activation in the early postsurgical phase, followed, after 24h, by transcriptional signatures of neuronal proliferation, neuronal death, and synaptic degradation. Neuron-specific transcriptome analysis confirmed these changes and verified the neuronal responses to the inflammatory environment. Simultaneously, our study revealed a neurodegenerative profile in macrophage-specific transcriptomes during POI. Depletion of macrophages before surgical manipulation led to decreased neuronal death, less synaptic decay, and improved GI motility, emphasizing the essential role of macrophages in neurodegeneration during intestinal neuroinflammation. In human jejunal muscularis externa samples, taken at early and late stages of pancreatectomies, we detected reactive and dying neurons with dysregulated gene expression of synaptic signaling and neurogenic processes. Conclusion: Surgical trauma and acute intestinal inflammation activate enteric neurons and induce neurodegeneration with severe synaptic decay, predominantly mediated by resident macrophages. Future studies should focus on neuroprotective mechanisms to dampen neurodegeneration and promote faster recovery from postoperative inflammation and motility disturbances.

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The effect of postsurgery execise on recovery from colorectal cancer surgery

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