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Systematic Review and Meta-analysis of Objective Assessment of Physical Fitness in Patients Undergoing Colorectal Cancer Surgery

Lee, Chun Hin, Angus, M.B.B.S. (Hons.), P.G.Dip.Surg.Anat., F.R.A.C.S.1,2; Kong, Joseph, C, M.S., F.R.A.C.S2; Ismail, Hilmy, M.D., F.R.C.A., F.F.A.R.C.S. (I), F.A.N.Z.C.A.2,3; Riedel, Bernhard, M.B.Ch.B., M.Med., F.C.A., F.A.S.E., F.A.N.Z.C.A., M.B.A., Ph.D.2,3; Heriot, Alexander, M.A., M.B., B.Chir., M.D., F.R.C.S. (Gen.), F.R.C.S.Ed., F.R.A.C.S1,2

Diseases of the Colon & Rectum: March 2018 - Volume 61 - Issue 3 - p 400–409
doi: 10.1097/DCR.0000000000001017
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BACKGROUND: Gas exchange-derived variables obtained from cardiopulmonary exercise testing allow objective assessment of functional capacity and hence physiological reserve to withstand the stressors of major surgery. Field walk tests provide an alternate means for objective assessment of functional capacity that may be cheaper and have greater acceptability, in particular, in elderly patients.

OBJECTIVE: This systematic review evaluated the predictive value of cardiopulmonary exercise testing and field walk tests in surgical outcomes after colorectal surgery.

DATA SOURCE: A systematic search was undertaken using Medline, PubMed, Embase, CINAHL, and PEDro.

STUDY SELECTION: Adult patients who had cardiopulmonary exercise testing and/or field walk test before colorectal surgery were included.

MAIN OUTCOME MEASURE: The primary outcomes measured were hospital length of stay and postoperative morbidity and mortality.

RESULTS: A total of 7 studies with a cohort of 1418 patients who underwent colorectal surgery were identified for inclusion in a qualitative analysis. Both pooled oxygen consumption at anaerobic threshold (range, 10.1–11.1 mL·kg–1·min–1) and peak oxygen consumption (range, 16.7–18.6 mL·kg–1·min–1) were predictive of complications (OR for anaerobic threshold, 0.76; 95% CI, 0.66–0.85, p<0.0001; OR for peak oxygen consumption, 0.76; 95% CI, 0.67–0.85, p<0.0001). Patients had significant increased risk of developing postoperative complications if their anaerobic threshold was below this cut point (p<0.001). However, it was not predictive of anastomotic leak (p = 0.644). Shorter distance (<250 m) walked in incremental shuttle walk test, lower anaerobic threshold, and lower peak oxygen consumption were associated with prolonged hospital length of stay, which was closely related to the development of complications.

CONCLUSIONS: Variables derived from cardiopulmonary exercise testing are predictive of postoperative complications and hospital length of stay. Currently, there are insufficient data to support the predictive role of the field walk test in colorectal surgery.

1 Epworth Healthcare, Melbourne, Victoria, Australia

2 Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia

3 Department of Anaesthetics, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia

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Funding/Support: None reported.

Financial Disclosure: None reported.

Correspondence: Chun Hin Angus Lee, M.B.B.S. (Hons.), P.G.Dip.Surg.Anat., F.R.A.C.S., Division of Cancer Surgery, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia, VIC 3000. E-mail:

© 2018 The American Society of Colon and Rectal Surgeons