NÍVEIS DE ATIVIDADE FÍSICA PRÉ-OPERATÓRIA E PROGNÓSTICO PÓS-CIRÚRGICO EM DOENTES ONCOLÓGICOS: UM ESTUDO OBSERVACIONAL PROSPETIVO

  • Rodrigo Cardoso Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
  • Mariana Guedes Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
  • Nicolle Pauli Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
  • Gabriela Ehrenbrink Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
  • Keily Poças Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
  • Carolina Castro Experimental Pathology and Therapeutics Group, Portuguese Oncology Institute of Porto FG, EPE (IPO-Porto), Porto, Portugal http://orcid.org/0000-0001-8156-4470
  • Carla Salomé Santos Experimental Pathology and Therapeutics Group, Portuguese Oncology Institute of Porto FG, EPE (IPO-Porto), Porto, Portugal
  • Cristine Schmidt Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal; Cardiovascular R& D Center (UnIC) and Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal http://orcid.org/0000-0002-8090-2068
  • Daniel Moreira-Gonçalves Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal; Experimental Pathology and Therapeutics Group, Portuguese Oncology Institute of Porto FG, EPE (IPO-Porto), Porto, Portugal http://orcid.org/0000-0002-7404-7405

Resumo




Introdução: Há um interesse crescente em entender o impacto dos níveis de atividade física (AF) pré-operatória na morbimortalidade pós-operatória. O presente trabalho teve como objetivo avaliar os níveis de AF em doentes com cancro da cabeça/pescoço ou estômago e comparar o desfecho pós-operatório entre aqueles que “aderem” ou “não aderem” às recomendações de AF. 





Métodos: Foi realizado um estudo observacional, longitudinal e prospetivo em doentes recém-diagnosticados com cancro da cabeça/pescoço ou estômago, recrutados no IPO-Porto. Os níveis de AF foram avaliados por acelerometria. Os dados sobre o desfecho pós-operatório (complicações, tempo de internamento e mortalidade) foram consultados nos registos clínicos.


Resultados: Foram recrutados 81 doentes, a maioria homens (76,5%), com idade média de 61,8 ± 11,55 anos, peso de 69,08 ± 15,55 kg e IMC de 25,82 ± 5,29 kg / m2. Cinquenta e quatro doentes tinham diagnóstico de cancro do estômago (66,7%) e 27 tinham cancro da cabeça/pescoço (33,3%). Os doentes passaram 54% do tempo de uso em comportamento sedentário, 42% em AF leve e 4% em AF moderada a vigorosa (AFMV). A mediana semanal de AFMV foi de 132 (3-1860) min, e apenas 46,9% dos doentes cumpriram as recomendações mínimas de AFMV / semana. Não foram observadas diferenças entre os doentes cancro da cabeça/pescoço ou estômago. Em relação ao desfecho pós-operatório, 23,4% dos doentes apresentaram complicações minor e 12,5%, complicações major. O tempo de internamento hospitalar foi de 13,86 ± 15,58 dias e ocorreram 9,9% mortes no período pós-operatório. A mortalidade pós-operatória foi superior entre os doentes que ou “não aderem” as recomendações internacionais de AF (7 vs. 1 óbito).


Conclusão: Os nossos dados sugerem que níveis elevados de AF no pré-operatório reduzem o risco de mortalidade pós-operatória. A avaliação dos níveis de AF pré-operatória poderá auxiliar na identificação dos doentes com maior risco cirúrgico e orientá-los para intervenções de otimização pré-operatória, como a pré-habilitação.







Downloads

Dados de Download não estão ainda disponíveis.

Referências

1. Sullivan, R., et al., Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol, 2015. 16(11): p. 1193-224.

2. Ethun, C.G., et al., Frailty and cancer: Implications for oncology surgery, medical oncology, and radiation oncology. CA: A Cancer Journal for Clinicians, 2017. 67(5): p. 362-377.

3. Tevis, S.E. and G.D. Kennedy, Postoperative complications and implications on patient-centered outcomes. J Surg Res, 2013. 181(1): p. 106-13.

4. Jhanji, S., et al., Mortality and utilisation of critical care resources amongst high-risk surgical patients in a large NHS trust. Anaesthesia, 2008. 63(7): p. 695-700.

5. Ferraris, V.A., et al., Identification of patients with postoperative complications who are at risk for failure to rescue. JAMA Surg, 2014. 149(11): p. 1103-8.

6. Papenfuss, W.A., et al., Morbidity and mortality associated with gastrectomy for gastric cancer. Ann Surg Oncol, 2014. 21(9): p. 3008-14.

7. Chiu, H.C., et al., The impact of complications on prolonged length of hospital stay after resection in colorectal cancer: A retrospective study of Taiwanese patients. J Int Med Res, 2017. 45(2): p. 691-705.

8. Vonlanthen, R., et al., The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients. Ann Surg, 2011. 254(6): p. 907-13.

9. Krarup, P.-M., et al., Anastomotic Leak Increases Distant Recurrence and Long-Term Mortality After Curative Resection for Colonic Cancer: A Nationwide Cohort Study. Annals of Surgery, 2014. 259(5): p. 930-938.

10. Mavros, M.N., et al., Impact of complications on long-term survival after resection of colorectal liver metastases. Br J Surg, 2013. 100(5): p. 711-8.

11. Artinyan, A., et al., Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg, 2015. 261(3): p. 497-505.

12. Pinto, A., et al., Surgical complications and their impact on patients’ psychosocial well-being: a systematic review and meta-analysis. BMJ Open, 2016. 6(2): p. e007224.

13. Lynch, B.M., et al., Don’t take cancer sitting down. Cancer, 2013. 119(11): p. 1928-1935.

14. McTiernan, A., et al., Physical Activity in Cancer Prevention and Survival: A Systematic Review. Med Sci Sports Exerc, 2019. 51(6): p. 1252-1261.

15. CAMPBELL, K.L., et al., Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Medicine & Science in Sports & Exercise, 2019. 51(11): p. 2375-2390.

16. Sarfati, D., B. Koczwara, and C. Jackson, The impact of comorbidity on cancer and its treatment. CA: A Cancer Journal for Clinicians, 2016. 66(4): p. 337-350.

17. Christensen, J.F., C. Simonsen, and P. Hojman, Exercise Training in Cancer Control and Treatment. Compr Physiol, 2018. 9(1): p. 165-205.

18. Steffens, D., et al., Is preoperative physical activity level of patients undergoing cancer surgery associated with postoperative outcomes? A systematic review and meta-analysis. Eur J Surg Oncol, 2019. 45(4): p. 510-518.

19. Vassbakk-Brovold, K., et al., Cancer patients participating in a lifestyle intervention during chemotherapy greatly over-report their physical activity level: a validation study. BMC Sports Sci Med Rehabil, 2016. 8: p. 10.

20. Chen, K.Y. and D.R. Bassett, Jr., The technology of accelerometry-based activity monitors: current and future. Med Sci Sports Exerc, 2005. 37(11 Suppl): p. S490-500.

21. Sasaki, J.E., D. John, and P.S. Freedson, Validation and comparison of ActiGraph activity monitors. J Sci Med Sport, 2011. 14(5): p. 411-6.

22. Aguilar-Farías, N., W.J. Brown, and G.M. Peeters, ActiGraph GT3X+ cut-points for identifying sedentary behaviour in older adults in free-living environments. J Sci Med Sport, 2014. 17(3): p. 293-9.

23. Clavien, P.A., et al., The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009. 250(2): p. 187-96.

24. Baba, Y., et al., Prognostic Impact of Postoperative Complications in 502 Patients With Surgically Resected Esophageal Squamous Cell Carcinoma: A Retrospective Single-institution Study. Ann Surg, 2016. 264(2): p. 305-11.

25. Yamashita, K., et al., Postoperative Infectious Complications are Associated with Adverse Oncologic Outcomes in Esophageal Cancer Patients Undergoing Preoperative Chemotherapy. Ann Surg Oncol, 2016. 23(6): p. 2106-14.

26. Malleo, G. and C.M. Vollmer, Jr., Postpancreatectomy Complications and Management. Surgical Clinics, 2016. 96(6): p. 1313-1336.

27. Baehring, E. and R. McCorkle, Postoperative complications in head and neck cancer. Clinical journal of oncology nursing, 2012. 16(6): p. 203-209.

28. Ciesielski, M., et al., Analysis of postoperative morbidity and mortality following surgery for gastric cancer. Surgeon volume as the most significant prognostic factor. Przeglad gastroenterologiczny, 2017. 12(3): p. 215-221.

29. Alves, A., et al., Postoperative Mortality and Morbidity in French Patients Undergoing Colorectal Surgery: Results of a Prospective Multicenter Study. Archives of Surgery, 2005. 140(3): p. 278-283.

30. Bhattacharyya, N. and M.P. Fried, Benchmarks for Mortality, Morbidity, and Length of Stay for Head and Neck Surgical Procedures. Archives of Otolaryngology–Head & Neck Surgery, 2001. 127(2): p. 127-132.

31. Schultz, P., et al., Perioperative mortality in oncologic head and neck surgery. J Otolaryngol, 2005. 34(3): p. 160-5.

32. Mason, M.C., et al., Preoperative cancer cachexia and short-term outcomes following surgery. J Surg Res, 2016. 205(2): p. 398-406.

33. Tønnesen, H., et al., Smoking and alcohol intervention before surgery: evidence for best practice. BJA: British Journal of Anaesthesia, 2009. 102(3): p. 297-306.

34. Campbell, K.L., et al., Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc, 2019. 51(11): p. 2375-2390.

35. Douma, J.A.J., et al., Demographic, clinical and lifestyle-related correlates of accelerometer assessed physical activity and fitness in newly diagnosed patients with head and neck cancer. Acta Oncologica, 2020. 59(3): p. 342-350.

36. Steindorf, K., et al., Change patterns and determinants of physical activity differ between breast, prostate, and colorectal cancer patients. Supportive Care in Cancer, 2020. 28(7): p. 3207-3218.

37. Dronkers, J.J., et al., The association of pre-operative physical fitness and physical activity with outcome after scheduled major abdominal surgery. Anaesthesia, 2013. 68(1): p. 67-73.

38. Moran, J., et al., The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: A systematic review and meta-analysis. Surgery, 2016. 160(5): p. 1189-1201.

39. Gillis, C., et al., Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology, 2018. 155(2): p. 391-410.e4.

40. Kamarajah, S.K., et al., Critical appraisal on the impact of preoperative rehabilitation and outcomes after major abdominal and cardiothoracic surgery: A systematic review and meta-analysis. Surgery, 2020. 167(3): p. 540-549.

41. Hughes, M.J., et al., Prehabilitation Before Major Abdominal Surgery: A Systematic Review and Meta-analysis. World J Surg, 2019. 43(7): p. 1661-1668.

42. Vasavada, B. and H. patel, Non surgical procedure related postoperative Complications independently predicts perioperative mortality, in gastrointestinal and Hpb surgeries.- A retrospective Analysis of prospectively maintained data. medRxiv, 2020: p. 2020.04.17.20068940.

43. Barberan-Garcia, A., et al., Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Ann Surg, 2018. 267(1): p. 50-56.
Publicado
2022-02-02
Como Citar
CARDOSO, Rodrigo et al. NÍVEIS DE ATIVIDADE FÍSICA PRÉ-OPERATÓRIA E PROGNÓSTICO PÓS-CIRÚRGICO EM DOENTES ONCOLÓGICOS: UM ESTUDO OBSERVACIONAL PROSPETIVO. Revista Portuguesa de Cirurgia, [S.l.], n. 51, p. 53-61, feb. 2022. ISSN 2183-1165. Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/932>. Acesso em: 26 june 2022. doi: https://doi.org/10.34635/rpc.932.
Secção
Artigos Originais

Trabalhos mais lidos do mesmo autor(es)