Prehabilitation in colorectal cancer patients scheduled for elective colorectal resection

Abdominal surgical interventions in elderly patients with colorectal cancer are
increasing. According to the Dutch Surgcial Colorectal Audit, 33 percent of the
colorectal patients have one ore more postoperative complications after
elective colon surgery. The elderly in particular are prone to postoperative
complications. Studies show that an anaerobic threshold below 11 ml/kg/min is a
good predictor of postoperative complications. Patients with an anaerobic
threshold below 11 ml/kg/min are considered high-risk. Current studies show
that high-risk patients who were placed on an exercise program before elective
surgery, improve their cardiopulmonary capacity. Based on an interim analysis,
our hypothesis is that preoperative training of high-risk patients with
colorectal cancer reduces the postoperative complication rate from 73 to 33
percent.

The primary objective of the research is to measure the effect of a 3 week
prehabilitation program on the postoperative complications in patients with an
anaerobic threshold of <11 ml/kg/min who*ll undergo elective coloretal surgery
for colorectal cancer.
The secondary objectives are to observe what happens with the anaerobic
threshold and inspiratory muscle strength in the intervention group and the
control group. Also the effect of the prehabilitation program on the length of
stay in hospital will be observed.

This study is a multicenter prospective randomized controlled trial. The
interventions, prehabilitation versus usual care, are randomly assigned to the
patients.The effect of prehabilitation versus no prehabilitation will be
compared. This trial will run from fall 2013 untill all patients are included,
this will probably be in December 2018. The study will take place in Medisch
Spectrum Twente in Enschede and ZGT in Almelo.

27 patients will receive 3 weeks of physiotherapy before surgery. The
physiotherapy consists of one hour cardiopulmonary training on an exercise
bicycle, three times a week. The control group will receive regular health
care.

Only patients in the intervention group will in all likelihood benefit from the
study. Those in the control group will not benefit. The risk for adverse events
in this study is negligible. The patients will have to invest some extra time
during this study. They have to perform a cardiopulmonary exercise test twice,
which will take 1,5 hour. The intervention group will have to participate in
the physiotherapy training for 9 hours.