Mechanistic understanding of how preoperative exercise improves outcomes: a substudy of the NHMRC-funded PRIORITY trial

Mechanistic understanding of how preoperative exercise improves outcomes: a substudy of the NHMRC-funded PRIORITY trial

 

CIA: Dr Neil Pillinger

Major gastrointestinal cancers collectively carry significant morbidity and mortality and are one of the leading causes of disease burden in Australia. 

Project summary

Major gastrointestinal cancers collectively carry significant morbidity and mortality and are one of the leading causes of disease burden in Australia. They are amongst the most expensive cancers to treat surgically owing to the complexity of operative interventions and high rates of postoperative complications (ranging from 40 to 70%). Postoperative complications have a number of deleterious effects, including prolonged hospital stay, increased healthcare cost, greater chronic disease, functional limitation and reduced quality of life.

It has long been known that physical fitness determines postoperative outcomes and increasingly preoperative exercise has been evaluated as a means of improving patients’ outcomes, but the mechanistic effects remain poorly explored. In this randomised controlled trial, inflammatory biomarkers and indices of organ injury will be collected before and after major abdominal cancer surgery in patients randomised to either structured exercise or usual care.

This sub-study of the NHMRC funded PRIORITY trial (Preoperative exercise for patients undergoing major abdominal cancer surgery) will disambiguate (1) whether exercise improves outcomes through the modulation of inflammation and (2) whether modulation of inflammation is associated changes with in perioperative cardiac and neuronal injury, delirium or long-term cognitive decline. Even a negative study will be highly relevant as it challenges the accumulating dogma about the role of the inflammatory response in determining clinical outcomes.

Chief investigators

Dr Neil Pillinger, Associate Professor John Loadsman, Dr Tim McCulloch, Royal Prince Alfred Hospital NSW, Dr Hilmy Ismail, Peter MacCallum Cancer Centre, Melbourne.
 

Funding

The project was awarded $A69,968 through the ANZCA research grants program for 2022.   

Last updated 14:36 8.03.2022