Effect of preoperative exercise on postoperative complications after colorectal cancer surgery in older people with low physical fitness: The CANOPTIPHYS randomised controlled trial

Introduction: Preoperative exercise may decrease the risk of complications after major abdominal cancer surgery but the amount of time available for such interventions is limited. Our objective was to evaluate the effect of a short-term preoperative exercise program on postoperative outcomes in older patients with low physical fitness scheduled to undergo colorectal cancer surgery. Materials and Methods: This was a randomised controlled, multicentre trial where patients scheduled for colorectal cancer surgery were considered for inclusion if they were >= 65 years of age and had low maximal walking speed. The intervention took place in participants' home environments and included inspiratory muscle training, aerobic training, and strength exercises for two to three weeks before surgery. Exercise was of high intensity and frequency, with at least six sessions supervised by a physiotherapist. Additionally, participants were instructed to perform unsupervised exercises, aiming for a total frequency of inspiratory muscle training twice daily, and aerobic and strength exercises five to six times per week. A control group underwent surgery without preoperative exercise. The primary endpoint was occurrence of any complications within 30 days after surgery. Secondary outcomes were postoperative length of hospital stay and discharge destination. Binary logistic regression and Mann-Whitney U test were used to analyse outcomes. Results: A total of 51 patients were included in the intention-to-treat analysis and allocated to preoperative exercise (n = 27) or usual care (n = 24). The proportion of participants with at least one postoperative complication was 48.1 % in the intervention group and 62.5 % in the control group. There was no effect of preoperative exercise on the odds of developing postoperative complications (OR: 0.56, 95 % CI: 0.18-1.71) nor on discharge to another care facility instead of home (OR: 0.98, 95 % CI: 0.29-3.27). The median length of stay in nights was 5 (IQR: 4-6) for the intervention group and 5.5 (IQR: 4-7.8) for the control group (p = 0.55). Discussion: In this study of older patients with low physical fitness awaiting colorectal cancer surgery, we could not demonstrate an influence of preoperative exercise on postoperative complications, discharge destination or length of hospital stay. These results should be interpreted with caution due to a small sample size.