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Surgical resection of primary tumour improves aerobic performance in colorectal cancer

Williams, John P.; Nyasavajjala, Sitaramachandra M.; Phillips, Beth E.; Chakrabarty, M.; Lund, Jonathan N.


John P. Williams

Sitaramachandra M. Nyasavajjala

Beth E. Phillips

M. Chakrabarty

Jonathan N. Lund



Colorectal cancer is the third most common cancer in the UK, with patients suffering declines in muscle mass and aerobic function. We hypothesised that tumour removal in non-metastatic colorectal cancer would lead to a restoration of lean muscle mass and increases in objective and subjective measures of aerobic performance.

We recruited two groups: patients with colorectal cancer (n = 30, 65.3 (51–77) y, body mass index 27.67 (4.83) kg m−2) and matched controls (n = 30, 64.6 (42–77) y, BMI 27.14 (3.51) kg m−2). Controls underwent a single study while colorectal cancer patients were studied before and 10 months after tumour resection. Aerobic performance was assessed via cardiopulmonary exercise testing and activity questionnaires. Lean muscle mass was measured via dual-energy X-ray absorptiometry.

Lean muscle mass was not different between groups (control: 47.82 (8.23); pre-resection: 52.41 (10.59); post-resection: 52.38 (10.52), kg). Anaerobic threshold was lower in pre-operative patients compared to controls (14.40 (3.23) vs. 19.67 (5.81) ml kg−1 min−1, p < 0.0001), increasing significantly post-resection (17.00 (3.56) ml kg−1 min−1 p < 0.0001). Self reported maximal physical activity was lower after resection compared to preoperatively (pre-resection 6.0 (6.5–5 IQR), post-resection 3.75 (4–3 IQR), p < 0.0001).

In colorectal cancer, anaerobic threshold is reached more rapidly than in matched controls, returning toward normal with tumour resection. Self-reported measures of activity do not mirror this objective change, cardiopulmonary exercise testing may therefore allow for a more accurate evaluation of pre and postoperative performance capability. The variance between objective and subjective measures of exercise capacity may be important in determining return to normal activities.

Journal Article Type Article
Publication Date Feb 1, 2014
Journal European Journal of Surgical Oncology (EJSO)
Electronic ISSN 0748-7983
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 40
Issue 2
APA6 Citation Williams, J. P., Nyasavajjala, S. M., Phillips, B. E., Chakrabarty, M., & Lund, J. N. (2014). Surgical resection of primary tumour improves aerobic performance in colorectal cancer. EJSO - European Journal of Surgical Oncology, 40(2), doi:10.1016/j.ejso.2013.11.009
Keywords Surgery; Aerobic performance; Colorectal cancer
Publisher URL
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf