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Purpose: The purpose of this study is to see if the distance to a hospital performing colon cancer surgery is a risk factor for emergency surgical intervention and to determine the variability between defined but demographically divergent catchment areas.

Methods: Data on patients living in Västerbotten County who underwent colon cancer surgery between 2007 and 2010 were extracted from the Swedish Colorectal Cancer Register (SCRCR). Of the 436 registrations matching these criteria, 380 patients were used in the analysis, and their distance to the nearest hospital providing care for colorectal cancer (CRC) was estimated using Google Maps™. The correlations between the risk for emergency surgery and the distance to a hospital, gender, age, income level and hospital catchment area were analysed in uni- and multivariate models.

Results: Distance to the nearest hospital had no significant effect on the proportion of emergency operations for colon cancer. There was significant variability in risk for emergency surgery between hospital catchment areas, where the catchment areas of the university hospital and the most rural hospital had a higher proportion than the other local hospital catchment area (OR, 2.00 (p = 0.038) and OR, 2.97 (p = 0.005)). These results were still significant when analysed with multivariate logistic regression (OR, 2.13 (p = 0.026) and OR, 3.05 (p = 0.013)).

Conclusion: Distance to a hospital performing colon cancer surgery had no effect on the proportion of emergency surgeries. However, a variability between defined catchment areas was seen. Future studies will focus on possible factors behind this variability.

AIM: The aim of this study was to investigate if patients with a weak social network and colon cancer are more likely to be operated as an emergency than those with a strong social network.

METHODS: Data from patients living in Västerbotten County, Sweden, who underwent colon cancer surgery between 2007 and 2020 were extracted from the Swedish Colorectal Cancer Registry (SCRCR). Patients identified were matched against the Västerbotten Intervention Program (VIP) and the longitudinal study Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA). These two databases include a survey that includes questions regarding quality and size of the patient's social network. Multivariable logistic regression was used for analysis.

RESULTS: Six items from the questions on social network, and the composite variables availability of social integration (AVSI) and availability of attachment (AVAT) were analysed. Data from 801 patients were analysed. The odds ratio for emergency surgery was significantly higher for divorced patients (OR 2.01 (CI 1.03-3.91)) and for male gender (OR 1.51 (CI 1.02-2.24)). A higher OR was seen amongst those with no-one to share feelings with (OR 1.57 (CI 0.82-3.03)) or to comfort them (OR1.33 (CI 0.78-2.28)). Quantitative aspects of social life such as the number of people greater than 10 that feel relaxed at the patient's home, showed a lower OR (OR 0.71(CI 0.35-1.43)).

CONCLUSION: The impact of social network on the risk for emergency surgery for colon cancer is limited. Divorced status and male gender were associated with an increased risk for emergency surgery.

Aim

To evaluate the association between objectively assessed preoperative physical activity and postoperative complication rate in colon cancer surgery.

Method

A prospective cohort study including 84 patients planned for elective colon cancer surgery. Preoperative physical function tests focusing on muscle strength and fitness were performed, and data from, body DXA scan, and accelerometer were collected. Logistic regression analyses were used to assess any association between preoperative physical status, MVPA (Moderate to Vigorous Physical Activity), or ASMI (Appendicular Skeletal Muscle Mass Index) with postoperative complication rate.

Results

Complications rated Clavien-Dindo ≥ 2 were seen in 15% of participants. High physical activity preoperatively was associated with a significant reduction in complication rate in the univariable analysis (OR 0.94, 95% CI 0.88-0.99, p=0.02). The mean daily MVPA in the group without complications was 40.2 minutes versus 9.2 minutes in the group with complications. In both univariable and multivariable analyses, there was a significantly lower complication rate associated with higher ASMI (OR 0.41, 95% CI 0.19-0.91, p=0.03).

Conclusion

This study shows that higher preoperative physical activity and muscle mass are associated with a lower postoperative complication rate. Physical activity recommendations should be given to all patients scheduled for elective colon cancer surgery.

Registry: Clinicaltrials.gov, TRN. NCT03947840, Registration date: 30 January 2019.

Abstract

Colon cancer surgery is associated with substantial postoperative decline in physical function, and preoperative physical status has been suggested to influence long-term recovery. However, evidence on how preoperative activity levels affect outcome up to one year after surgery remains limited.Our aim was to use objective data to evaluate how preoperative physical activity and status among colon cancer patients affects outcome six months and one year after colon cancer surgery.

Method

This prospective cohort study included 84 patients planned for elective colon cancer surgery. Preoperative physical function tests focusing on muscle strength and fitness were performed, and body DXA scan and accelerometer measurements were collected. Differences between pre- and postoperative measurements were analysed using linear mixed effect models. In the multivariable models, gender and adjuvant treatment were used as covariates.

Results

There was an increase in muscle mass despite a decrease in physical activity. Appendicular Skeletal Muscle Mass Index (ASMI) increased in both the uni- and multivariable model for both the 6- and 12-month follow-ups. Moderate to Vigorous Physical Activity (MVPA) decreased significantly at 12 months. Of the physical tests, an improvement in the 2-minute step test at 12 months was seen. Those patients who received adjuvant therapy had higher ASMI and MVPA than those who did not. These trends were the same in both groups.

Conclusion

Significant recovery in terms of greater muscle mass and better 2-min step test results was seen 6 and 12 months after colon cancer surgery despite a significant decline in physical activity. This knowledge is important when planning and designing studies on rehabilitation after surgery and prehabilitation.

Register: Clinicaltrials.gov, TRN. NCT03947840, Registration date: 30 January 2019.