Single session preoperative breathing exercise education may influence postoperative outcomes in open colorectal cancer surgery

Abstract

Background: Preoperative prehabilitation is a set of interventions leading to better post-treatment outcomes. Prehabilitation protocols in colorectal cancer surgery lack standardization. We retrospectively analyzed the impact of a preoperative breathing exercise session as an additional intervention. Aim: This study analyzes the potential benefits of breathing exercises for opera singers on patients’ outcomes after open colorectal cancer surgery. Methods: We analyzed a database of colorectal cancer patients from January 2019 until May 2020 at a single cancer center, extracting age, sex, tumor localization, and complications that required medical or surgical interventions in 30 days postoperative period (graded according to the Clavien-Dindo classification), and 365 days post-surgery, and completion of chemotherapy protocol. Then, we compared the existing prehabilitation protocol (nutritional intervention with commercially available pharmaconutrition based on NRS-2002 scores; three times a week aerobic exercise including 30 minutes on a bicycle or targeted walking distance of 5000 or 10000 steps based on individual’s capacities starting at least two weeks before surgery), from the experimental protocol (breathing exercises for opera singers with relaxation session with music therapy). Endpoints were short term and long-term complications, ICU/hospitalization length, and chemotherapy completion. Results: We included 291 colorectal cancer patients, 173 males, and 118 females, mean age 66 years, of whom 31 (10.7%) completed the experimental protocol breathing exercise for opera singers. Patients of the control and experimental group had comparable demographics and tumor-associated characteristics at baseline. Experimental breathing protocol was associated with a shorter duration of ICU stay (χ 2 =4.132, df=1, p=0.047). However, it did not influence other parameters (length of stay on the ward, short-term and long-term complications, and ability to complete the treatment protocol). The binary regression analysis showed that patients with an NRS-2002 score of 5, with higher BMI and advanced age, would benefit the most from the suggested respiratory prehabilitation protocol. Conclusion: The addition of breathing exercises might benefit CRC patients by reducing time spent in the ICU and postoperative respiratory complications. Again, this needs to be tested in a larger cohort.

Keywords

• prehabilitation
• colorectal cancer
• outcomes
• prognosis
• breathing exercises