Skip to main content

Advertisement

SpringerLink
Log in

The effect of preoperative rehabilitation on the prevention of postoperative ileus in colorectal cancer patients

  • Research
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Previous research suggests that the preoperative rehabilitation of colorectal cancer patients can reduce postoperative ileus. However, the evidence is insufficient and further research is warranted. This study aimed to investigate whether short-term preoperative rehabilitation, both on an outpatient and inpatient basis, can reduce the incidence of postoperative ileus after colorectal cancer surgery.

Methods

This was a retrospective cohort study that drew on data from multicenter electronic medical records. Patients with stage 1–3 colorectal cancer who underwent surgery and postoperative rehabilitation were included. The incidence of postoperative ileus was compared between patients who received short-term preoperative rehabilitation and those who did not. Propensity score adjustment using inverse probability weighting and subgroup analysis by type of surgery was performed.

Results

Four thousand seventy-six eligible patients (43.4% female; mean age 75.1 ± 10.9 years) were included; 1914 (47.0%) received short-term preoperative rehabilitation. The preoperative rehabilitation group had a significantly lower incidence of postoperative ileus than the no preoperative rehabilitation group (pre-adjustment: 5.5% vs. 9.9%, p < 0.001; post-adjustment: 5.2% vs. 9.0%, p < 0.001). Therefore, preoperative rehabilitation was significantly associated with a lower incidence of postoperative ileus (OR: 0.554, 95% CI: 0.415–0.739, p < 0.001). In an adjusted analysis of surgery type subgroups, the incidence of postoperative ileus was significantly lower in the preoperative rehabilitation group for all types of surgery.

Conclusion

Our study showed that short-term preoperative rehabilitation for patients with stage 1–3 colorectal cancer, both with inpatients and outpatients, significantly reduces the incidence of postoperative ileus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The data from this research is available from the corresponding author upon reasonable request.

Code availability

Not applicable.

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249

    Article  PubMed  Google Scholar 

  2. Kirchhoff P, Clavien PA, Hahnloser D (2010) Complications in colorectal surgery: risk factors and preventive strategies. Patient Saf Surg 4:5

    Article  PubMed  PubMed Central  Google Scholar 

  3. Boeckxstaens GE, de Jonge WJ (2009) Neuroimmune mechanisms in postoperative ileus. Gut 58:1300–1311

    Article  CAS  PubMed  Google Scholar 

  4. Gan TJ, Robinson SB, Oderda GM, Scranton R, Pepin J, Ramamoorthy S (2015) Impact of postsurgical opioid use and ileus on economic outcomes in gastrointestinal surgeries. Curr Med Res Opin 31:677–686

    Article  CAS  PubMed  Google Scholar 

  5. Bolshinsky V, Ismail H, Li M, Basto J, Schier R, Hagemeier A, Ho KM, Heriot A, Riedel B (2022) Clinical covariates that improve surgical risk prediction and guide targeted prehabilitation: an exploratory, retrospective cohort study of major colorectal cancer surgery patients evaluated with preoperative cardiopulmonary exercise testing. Perioper Med 11:20

    Article  Google Scholar 

  6. Bojesen RD, Grube C, Buzquurz F, Miedzianogora REG, Eriksen JR, Gogenur I (2022) Effect of modifying high-risk factors and prehabilitation on the outcomes of colorectal cancer surgery: controlled before and after study. BJS Open 6:029

  7. Berkel AEM, Bongers BC, Kotte H, Weltevreden P, de Jongh FHC, Eijsvogel MMM, Wymenga M, Bigirwamungu-Bargeman M, van der Palen J, van Det MJ, van Meeteren NLU, Klaase JM (2022) Effects of community-based exercise prehabilitation for patients scheduled for colorectal surgery with high risk for postoperative complications: results of a randomized clinical trial. Ann Surg 275:e299–e306

    Article  PubMed  Google Scholar 

  8. de Klerk M, van Dalen DH, Nahar-van Venrooij LMW, Meijerink W, Verdaasdonk EGG (2021) A multimodal prehabilitation program in high-risk patients undergoing elective resection for colorectal cancer: a retrospective cohort study. Eur J Surg Oncol 47:2849–2856

    Article  PubMed  Google Scholar 

  9. Watanabe T, Momosaki R, Suzuki S, Abo M (2020) Preoperative rehabilitation for patients undergoing colorectal cancer surgery: a retrospective cohort study. Support Care Cancer 28:2293–2297

    Article  PubMed  Google Scholar 

  10. Knight KA, Moug SJ, West MA (2017) Systematic review: the impact of exercise on mesenteric blood flow and its implication for preoperative rehabilitation. Tech Coloproctol 21:185–201

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Peng LH, Wang WJ, Chen J, Jin JY, Min S, Qin PP (2021) Implementation of the pre-operative rehabilitation recovery protocol and its effect on the quality of recovery after colorectal surgeries. Chin Med J 134:2865–2873

    Article  PubMed  PubMed Central  Google Scholar 

  12. Carli F, Bousquet-Dion G, Awasthi R, Elsherbini N, Liberman S, Boutros M, Stein B, Charlebois P, Ghitulescu G, Morin N, Jagoe T, Scheede-Bergdahl C, Minnella EM, Fiore JF Jr (2020) Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer: a randomized clinical trial. JAMA Surg 155:233–242

    Article  PubMed  PubMed Central  Google Scholar 

  13. O’Doherty AF, West M, Jack S, Grocott MP (2013) Preoperative aerobic exercise training in elective intra-cavity surgery: a systematic review. Br J Anaesth 110:679–689

    Article  PubMed  Google Scholar 

  14. Orange ST, Northgraves MJ, Marshall P, Madden LA, Vince RV (2018) Exercise prehabilitation in elective intra-cavity surgery: a role within the ERAS pathway? A narrative review. Int J Surg 56:328–333

    Article  PubMed  Google Scholar 

  15. Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, Moriarty J, Wilson F (2016) The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surg 160:1189–1201

    Article  Google Scholar 

  16. Luther A, Gabriel J, Watson RP, Francis NK (2018) The impact of total body prehabilitation on post-operative outcomes after major abdominal surgery: a systematic review. World J Surg 42:2781–2791

    Article  PubMed  Google Scholar 

  17. Imai S, Kashiwagi H, Sato Y, Miyai T, Sugawara M, Takekuma Y (2022) Factors affecting creatine phosphokinase elevation during daptomycin therapy using a combination of machine learning and conventional methods. Br J Clin Pharmacol 88:1211–1222

    Article  CAS  PubMed  Google Scholar 

  18. Brinkman GL, Coates EO Jr (1963) The effect of bronchitis, smoking, and occupation on ventilation. Am Rev Respir Dis 87:684–693

    CAS  PubMed  Google Scholar 

  19. Austin PC, Stuart EA (2015) Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med 34:3661–3679

    Article  PubMed  PubMed Central  Google Scholar 

  20. Makary MA, Segev DL, Pronovost PJ, Syin D, Bandeen-Roche K, Patel P, Takenaga R, Devgan L, Holzmueller CG, Tian J, Fried LP (2010) Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 210:901–908

    Article  PubMed  Google Scholar 

  21. Loogman L, de Nes LCF, Heil TC, Kok DEG, Winkels RM, Kampman E, de Wilt JHW, van Duijnhoven FJB, Collaborative C, Collaborators C, Affiliations C (2021) The association between modifiable lifestyle factors and postoperative complications of elective surgery in patients with colorectal cancer. Dis Colon Rectum 64:1342–1353

    Article  PubMed  PubMed Central  Google Scholar 

  22. Milder DA, Pillinger NL, Kam PCA (2018) The role of prehabilitation in frail surgical patients: a systematic review. Acta Anaesthesiol Scand 62:1356–1366

    Article  PubMed  Google Scholar 

  23. Lee S, Collins EG (2021) Factors influencing physical activity after cardiac surgery: an integrative review. Heart Lung 50:136–145

    Article  PubMed  Google Scholar 

  24. Ahn KY, Hur H, Kim DH, Min J, Jeong DH, Chu SH, Lee JW, Ligibel JA, Meyerhardt JA, Jones LW, Jeon JY, Kim NK (2013) The effects of inpatient exercise therapy on the length of hospital stay in stages I-III colon cancer patients: randomized controlled trial. Int J Colorectal Dis 28:643–651

    Article  PubMed  Google Scholar 

  25. Barbieux J, Hamy A, Talbot MF, Casa C, Mucci S, Lermite E, Venara A (2017) Does enhanced recovery reduce postoperative ileus after colorectal surgery? J Visc Surg 154:79–85

    Article  CAS  PubMed  Google Scholar 

  26. Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, Liberman AS, Stein B, Charlebois P, Feldman LS, Carli F (2014) Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiol 121:937–947

    Article  Google Scholar 

  27. Dronkers JJ, Lamberts H, Reutelingsperger IM, Naber RH, Dronkers-Landman CM, Veldman A, van Meeteren NL (2010) Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study. Clin Rehabil 24:614–622

    Article  CAS  PubMed  Google Scholar 

  28. Swieszek D, Gedlek M, Kenig J (2015) The importance of prerehabilitation in the reduction of postoperative complications of elderly patients undergoing abdominal operations—systematic review. Pol Przegl Chir 87:47–52

    Article  PubMed  Google Scholar 

  29. Carli F, Zavorsky GS (2005) Optimizing functional exercise capacity in the elderly surgical population. Curr Opin Clin Nutr Metab Care 8:23–32

    Article  PubMed  Google Scholar 

  30. Northgraves MJ, Arunachalam L, Madden LA, Marshall P, Hartley JE, MacFie J, Vince RV (2020) Feasibility of a novel exercise prehabilitation programme in patients scheduled for elective colorectal surgery: a feasibility randomised controlled trial. Support Care Cancer 28:3197–3206

    Article  PubMed  Google Scholar 

  31. Yamana H, Moriwaki M, Horiguchi H, Kodan M, Fushimi K, Yasunaga H (2017) Validity of diagnoses, procedures, and laboratory data in Japanese administrative data. J Epidemiol 27:476–482

    Article  PubMed  PubMed Central  Google Scholar 

  32. Konishi T, Yoshimoto T, Fujiogi M, Yamana H, Tanabe M, Seto Y, Yasunaga H (2022) Validity of operative information in Japanese administrative data: a chart review-based analysis of 1221 cases at a single institution. Surg Today 52:1484–1490

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank the Health, Clinic, and Education Information Evaluation Institute, Kyoto, Japan for developing the secondary database for our study.

Funding

This study was supported by grants from RWD Clinical Research Grant Award.

Author information

Authors and Affiliations

  1. Department of Rehabilitation, Mie University Hospital, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Kenta Ushida, Yoshinori Yamamoto, Shinsuke Hori, Miho Shimizu, Yuki Kato & Ryo Momosaki

  2. Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan

    Yuji Toiyama & Yoshinaga Okugawa

  3. Department of Genomic Medicine, Mie University Hospital, Tsu, Mie, Japan

    Yoshinaga Okugawa

  4. Department of Health Science, Faculty of Health and Human Development, University of Nagano, Nagano, Japan

    Akio Shimizu

Authors
  1. Kenta Ushida
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshinori Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shinsuke Hori
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Miho Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yuki Kato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuji Toiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoshinaga Okugawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Akio Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ryo Momosaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: Kenta Ushida, Yoshinori Yamamoto, Shinsuke Hori, Miho Shimizu, Yuki Kato, Yuji Toiyama, Yoshinaga Okugawa, Akio Shimizu, Ryo Momosaki; methodology: Kenta Ushida, Yoshinori Yamamoto, Shinsuke Hori, Yuji Toiyama, Yoshinaga Okugawa, Ryo Momosaki; formal analysis and investigation: Kenta Ushida, Yoshinori Yamamoto, Shinsuke Hori, Yuji Toiyama, Yoshinaga Okugawa, Akio Shimizu, Ryo Momosaki; writing—original draft preparation: Kenta Ushida, Ryo Momosaki; writing—review and editing: Kenta Ushida, Yoshinori Yamamoto, Shinsuke Hori, Miho Shimizu, Yuki Kato, Yuji Toiyama, Yoshinaga Okugawa, Akio Shimizu, Ryo Momosaki; funding acquisition: Ryo Momosaki; resources: Ryo Momosaki; supervision: Ryo Momosaki.

Corresponding author

Correspondence to Ryo Momosaki.

Ethics declarations

Ethics approval

This study was conducted in accordance with the tenets of the 2013 revision of the Declaration of Helsinki. The protocol was approved by the Ethical Review Committee of Mie University Hospital (approval no.: H2021-040).

Consent to participate

The informed consent requirement was waived due to the retrospective nature of this study and the absence of identifying information.

Consent for publication

The informed consent requirement was waived due to the retrospective nature of this study and the absence of identifying information.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ushida, K., Yamamoto, Y., Hori, S. et al. The effect of preoperative rehabilitation on the prevention of postoperative ileus in colorectal cancer patients. Support Care Cancer 31, 123 (2023). https://doi.org/10.1007/s00520-023-07585-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-023-07585-x

Keywords

Search

Navigation