The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients M.A. West a,b,f, * , L. Loughney a,b,d , C.P. Barben a , R. Sripadam e , G.J. Kemp f , M.P.W. Grocott b,c,d , S. Jack b,d a Colorectal Surgery Research Group, Aintree University Hospitals NHS Foundation Trust, Liverpool, United Kingdom b Critical Care Research Area, Southampton NIHR Respiratory Biomedical Research Unit, Southampton, United Kingdom c Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom d Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom e Clatterbridge Cancer Centre, Wirral, United Kingdom f Department of Musculoskeletal Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom Accepted 22 March 2014 Available online --- Abstract 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-oper- ating characteristic (ROC) analysis defined the predictive value of CPET for in-hospital morbidity at day 5. Results: Oxygen uptake ( _ V O2 in ml kg 1 min 1 ) at estimated lactate threshold ð b q L Þ and at peak exercise ( _ V O2 at peak in ml kg 1 min 1 ) both significantly decreased post-NACRT: _ V O2 at b q L 12.1 (pre-NACRT) vs. 10.6 (post-NACRT), p < 0.001 (95%CI 1.7, 1.2); _ V O2 at peak 18.1 vs. 16.7, p < 0.001 (95%CI 3.1, 1.0). Optimal _ V O2 at b q L and peak pre-NACRT for predicting postoperative morbidity were 12.0 and 18.1 ( _ V O2 at b q L e AUC ¼ 0.71, 77% sensitive and 75% specific; _ V O2 at peak e AUC ¼ 0.75, 78% sensitive and 76% specific). Optimal _ V O2 at b q L and peak post-NACRT for predicting postoperative morbidity were 10.7 and 16.7 ( _ V O2 at b q L e AUC ¼ 0.72, 77% sen- sitive and 83% specific; _ V O2 at peak e AUC ¼ 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. Ó 2014 Elsevier Ltd. All rights reserved. Keywords: Neoadjuvant chemoradiotherapy; Cardiopulmonary exercise testing; Cancer surgery; Morbidity; Rectal cancer; Physical fitness Introduction In the United Kingdom colorectal cancer is the third commonest cause of cancer death. 1 In 2009, 33 600 new cases were registered in England (w1/3 rectal), with w13 000 deaths in 2010. 2 In 2012, of w9000 diagnosed with rectal cancer (35% over 75 years), 75% underwent major resection, 76% of whom had no worse than mild sys- temic disease (American Society of Anaesthesiologists (ASA) score of 1 or 2), with 90-day post-operative * Corresponding author. Aintree University Hospitals, Clinical Sciences Centre, 3rd Floor, Longmoore Lane, Liverpool L97AL, United Kingdom. Tel.: þ44 151 529 5882. E-mail addresses: mwest@liverpool.ac.uk, malwest@hotmail.com (M.A. West), lisa.loughney@uhs.nhs.uk (L. Loughney), chris.barben@ aintree.nhs.uk (C.P. Barben), rajaram.sripadam@ccotrust.nhs.uk (R. Sripadam), gkemp@liverpool.ac.uk (G.J. Kemp), mike.grocott@ soton.ac.uk (M.P.W. Grocott), s.jack@soton.ac.uk (S. Jack). 0748-7983/$ - see front matter Ó 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejso.2014.03.021 Available online at www.sciencedirect.com ScienceDirect EJSO xx (2014) 1e8 www.ejso.com Please cite this article in press as: West MA, et al., The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients, Eur J Surg Oncol (2014), http://dx.doi.org/10.1016/j.ejso.2014.03.021