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Cancers
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Preoperative Optimisation in Patients Undergoing Cancer Surgery
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Preoperative Optimisation in Patients Undergoing Cancer Surgery

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Survivorship and Quality of Life".

Deadline for manuscript submissions: 20 June 2025 | Viewed by 11257

Special Issue Editors

Dr. Daniel Steffens

E-Mail Website
Guest Editor
1. Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
2. Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
Interests: prehabilitation; patient screening; clinical trials; decision-making; effectiveness; cost-effectiveness; patient reported outcomes; quality of life; surgical outcomes; cancer surgery
Dr. Cherry Koh

E-Mail Website
Guest Editor
1. Colorectal Surgeon, Royal Prince Alfred Hospital, Syndey, Australia
2. Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
Interests: surgical approach; decision making; patient selection; surgical outcomes; colorectal cancer; minimally invasive surgery; complex surgery; patient reported outcomes

Special Issue Information

Dear Colleagues,

For selected patients presenting with cancer, surgery with or without chemoradiotherapy is the mainstream treatment option, with the main aim of removing all cancer cells. Despite the improved survival benefits, postoperative morbidity is still high. This slows the recovery period, with some patients needing to stay in hospital for a longer period of time, and this has the potential to adversely affect the patient’s quality of life.

Recently, prehabilitation was introduced to enhance general health and wellbeing before cancer surgery. There is some evidence suggesting that preoperative medical, physical, nutritional and psychological interventions may reduce postoperative morbidity rates, facilitate recovery and improve subsequent quality of life. However, the evidence around the effectiveness of preoperative optimisation is still in an embryonic phase. It is also unclear if preoperative patient optimisation should be offered more selectively to at-risk patient cohorts.

Thus, this Special Issue will cover all aspects of preoperative optimisation, including but not limited to:

  1. Original studies or systematic reviews evaluating the effectiveness of preoperative interventions (medical, physical, nutritional, and psychological) on reducing postoperative outcomes, length of hospital stay and improving quality of life in patients undergoing cancer surgery;
  2. Measures of association between preoperative factors (medical, physical, nutritional, and psychological) and postoperative surgical outcomes;
  3. Evidence gaps in prehabilitation, including research priorities and limitation of the current evidence;
  4. Applicability of different prehabilitation modes, including telehealth interventions.

Dr. Daniel Steffens
Dr. Cherry Koh
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • prehabilitation
  • medical optimisation
  • exercise
  • nutrition
  • psychological interventions
  • surgery
  • cancer
  • surgical outcome
  • preoperative
  • clinical trials

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Published Papers (7 papers)

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Research

14 pages, 1087 KiB  
Article
Effect of Preoperative Body Composition on Postoperative Anastomotic Leakage in Oncological Ivor Lewis Esophagectomy—A Retrospective Cohort Study
by Jonas Herzberg, Tim Strate, Leon Passlack, Salman Yousuf Guraya and Human Honarpisheh
Cancers 2024, 16(24), 4217; https://doi.org/10.3390/cancers16244217 - 18 Dec 2024
Viewed by 576
Abstract
Background: Surgery for esophageal cancer has an associated high rate of postoperative complications such as anastomotic leakage (AL) and fistulas. Pre-operative sarcopenia as a loss of skeletal muscle mass and function is identified as a potential prognostic factor in determining the outcomes of [...] Read more.
Background: Surgery for esophageal cancer has an associated high rate of postoperative complications such as anastomotic leakage (AL) and fistulas. Pre-operative sarcopenia as a loss of skeletal muscle mass and function is identified as a potential prognostic factor in determining the outcomes of oncological surgical resections for esophageal cancers. In this study, we evaluated the impact of body composition on postoperative complications in esophageal cancer surgery. Methods: In this cohort study, we analyzed patients’ body composition at the level of the third lumbar vertebra on CT scans before Ivor Lewis resections for esophageal cancers between January 2015 and December 2022. Patients with a skeletal muscle index (SMI) ≤ 38.5 cm2/m2 in women and ≤52.4 cm2/m2 in men were classified as sarcopenic. Postoperative complications were categorized following the Dindo–Clavien classification and included AL, postoperative pneumonia, length of hospital stay, and failure-to-rescue which were compared between the sarcopenic and non-sarcopenic patients. Results: From a group of 111 patients with Ivor Lewis esophagectomy, 70 patients (63.1%) were classified as sarcopenic based on the SMI and the previously published gender-specific cut-off values. AL occurred at 12.6% (5.6% in adenocarcinoma). Within the whole cohort, patients with AL had a significantly low SMI of 43.487 ± 8.088 vs. 48.668 ± 7.514; p = 0.012. Additionally, the SMI showed a negative correlation to the length of postoperative hospital stay (r = −0.204; p = 0.032; N = 111). The failure-to-rescue rate was higher in the group of sarcopenic patients (12.8% vs. 8%). Conclusions: Our data showed a correlation between SMI and AL. This effect could not be seen in gender-specific SMI. This study showed a lower failure-to-rescue rate in non-sarcopenic patients after Ivor Lewis esophagectomy. These findings underscore the crucial role of determining the preoperative nutritional and body composition status as measured by the preoperative CT scans. Full article
(This article belongs to the Special Issue Preoperative Optimisation in Patients Undergoing Cancer Surgery)
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14 pages, 1089 KiB  
Article
Perioperative Observations and Outcome in Surgical Treatment of Malignant Peripheral Nerve Sheath Tumors
by Julian Zipfel, Jonas Tellermann, Kevin Paul Ferraris, Florian Grimm, Antje Bornemann, Benjamin Bender, Helmut Dittmann, Jürgen Schäfer, Konstantin Nikolaou, Ruth Ladurner, Volker Steger, Marcos Tatagiba, Martin U. Schuhmann and Isabel Gugel
Cancers 2024, 16(22), 3757; https://doi.org/10.3390/cancers16223757 - 7 Nov 2024
Viewed by 856
Abstract
Background/Objectives: This retrospective observational study aimed to investigate the perioperative outcome in Malignant Peripheral Nerve Sheath Tumors (MPNSTs) with and without relation to Neurofibromatosis Type 1 (NF1) and to detect possible influencing factors. Methods: Clinical reports, histopathological evaluations, imaging, and treatment characteristics were [...] Read more.
Background/Objectives: This retrospective observational study aimed to investigate the perioperative outcome in Malignant Peripheral Nerve Sheath Tumors (MPNSTs) with and without relation to Neurofibromatosis Type 1 (NF1) and to detect possible influencing factors. Methods: Clinical reports, histopathological evaluations, imaging, and treatment characteristics were reviewed in 35 operated MPNSTs in 33 patients. Possible predictive valuables included disease type, preoperative tumor volume, SUV and MIB-1 proliferation index, resection margins, the presence of metastasis, and whether radio-/chemotherapy was received. Results: Patients with NF1 were younger (mean age: 29 ± 13, 8–54 years) than sporadic cases (mean age: 45 ± 13, 24–67 years) and exhibited significantly larger preoperative tumor volumes (mean 299 vs. 18 cm3, p = 0.048). Most tumors were located in the facial/cervical/neck area (34%, n = 12), followed by the trunk (31%, n = 11), lower extremity (17%, n = 6), upper extremity (14%, n = 5), and intraspinal area (3%, n = 1). NF1-associated MPNSTs appeared predominantly on the trunk (39%) and sporadically in the facial/cervical/neck area (50%). Complete resection was possible in 66% and an improvement in or stability of function was achieved in most cases (motor 69%, sensory 74%), as well as a decrease in pain intensity (63%). NF1-associated MPNSTs exhibited more severe pain scores (median VRS scale 2, p = 0.002) compared to sporadic tumors (median VRS scale 0.5). Sporadic MPNSTs located at the head/facial/brachial plexus and upper extremities exhibited better preoperative functions compared to those on the lower extremities. In 12 cases with available [18F]FDG PET, the mean preoperative SUV (9.8 ± 7.2) positively correlated with the mean maximum MIB-1 index (34 ± 26%, p = 0.005) and the mean preoperative tumor volume (474.7 ± 68.6 cm3, p = 0.047). The overall survival (OS) was significantly longer in tumors with higher resection extents (R0, p = 0.01) and without accompanying metastasis (p = 0.046), and tended to be longer, but not significantly so, in sporadic MPNSTs. In six and seven tumors, with R1/R2 resection margins and present metastasis, respectively, solid or combined neo-/adjuvant radio-/chemotherapy led to a significantly shorter OS (p = 0.014). Conclusions: NF1-associated MPNSTs have larger tumor volumes, higher SUVs and MIB-1 proliferation indices, and a shorter overall survival period. Nevertheless, surgery can improve symptoms, particularly medication-resistant pain, and should also be considered in advanced disease for symptom control/improvement. Full article
(This article belongs to the Special Issue Preoperative Optimisation in Patients Undergoing Cancer Surgery)
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12 pages, 784 KiB  
Article
Short- and Long-Term Advantages of Laparoscopic Gastrectomy for Elderly Patients with Locally Advanced Cancer
by Francesco Puccetti, Lorenzo Cinelli, Stefano Turi, Davide Socci, Riccardo Rosati, Ugo Elmore and on behalf of the OSR CCeR Collaborative Group
Cancers 2024, 16(13), 2477; https://doi.org/10.3390/cancers16132477 - 7 Jul 2024
Viewed by 1244
Abstract
Minimally invasive surgery has provided several clinical advantages in locally advanced gastric cancer (LAGC) care, although a consensus on its application criteria remains unclear. Surgery remains a careful choice in elderly patients, who frequently present with frailty, comorbidities, and other disabling diseases. This [...] Read more.
Minimally invasive surgery has provided several clinical advantages in locally advanced gastric cancer (LAGC) care, although a consensus on its application criteria remains unclear. Surgery remains a careful choice in elderly patients, who frequently present with frailty, comorbidities, and other disabling diseases. This study aims to assess the possible advantages of laparoscopic gastric resections in elderly patients presenting with LAGC. This retrospective study analyzed a single-center series of elderly patients (≥75 years) undergoing curative resections for LAGC between 2015 and 2020. A comparative analysis of open versus laparoscopic approaches was conducted, focusing on postoperative complications, length of hospital stay (LOS), and long-term survival. A total of 62 patients underwent gastrectomy through an open or a laparoscopic approach (31 pts each). The study population did not show statistically significant differences in demographics, operative risk, and neoadjuvant chemotherapy. The laparoscopic group reported significantly minimized overall complications (45.2 vs. 71%, p = 0.039) and pulmonary complications (0 vs. 9.7%, p = 0.038) as well as a shorter LOS (8 vs. 12 days, p = 0.007). Lymph node harvest was equal between the groups, although long-term overall survival presented significantly better after laparoscopic gastrectomy (p = 0.048), without a relevant difference in terms of disease-free and disease-specific survivals. Laparoscopic gastrectomy proves effective in elderly LAGC patients, offering substantial short- and long-term postoperative benefits. Full article
(This article belongs to the Special Issue Preoperative Optimisation in Patients Undergoing Cancer Surgery)
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13 pages, 271 KiB  
Article
Consumer Perspectives on the Adoption of a Prehabilitation Multimodal Online Program for Patients Undergoing Cancer Surgery
by Daniel Steffens, Linda Denehy, Michael Solomon, Cherry Koh, Nabila Ansari, Kate McBride, Sharon Carey, Jenna Bartyn, Aaron Sean Lawrence, Kym Sheehan and Kim Delbaere
Cancers 2023, 15(20), 5039; https://doi.org/10.3390/cancers15205039 - 18 Oct 2023
Cited by 3 | Viewed by 1999
Abstract
This study aimed to explore patients’ perspectives on the adoption of a prehabilitation multimodal online program. Patients recovering from gastrointestinal cancer surgery at a tertiary hospital between October 2021 and November 2022 were invited to participate. An e-Health program including intensity exercises, nutrition [...] Read more.
This study aimed to explore patients’ perspectives on the adoption of a prehabilitation multimodal online program. Patients recovering from gastrointestinal cancer surgery at a tertiary hospital between October 2021 and November 2022 were invited to participate. An e-Health program including intensity exercises, nutrition and psychological counselling was used. Patients were instructed to navigate the e-Health program over 24 h using an iPad and then complete the study survey. Patients’ characteristics, use of technology, views and minimal expected outcomes from a preoperative online program were collected. Of the 30 patients included, most were female, most reported confidence in the use of technology, most considered the online program safe and most agreed it would be beneficial for their health. “Poor preoperative health” and “lack of motivation and encouragement” were identified as the main barriers to the uptake of a preoperative online program, while program ‘simplicity’ and perceived ‘benefits’ were the main facilitators. Significant improvement in postoperative outcomes is perceived to influence patients’ willingness to participate in a preoperative multimodal e-Health program. Gastrointestinal cancer patients perceived the adoption of a preoperative multimodal e-Health application as safe to be performed at home and of potential benefit to their health. A range of patient’s characteristics, barriers and facilitators to the uptake of an online program were identified. These should be considered in future preoperative multimodal online programs to enhance patient experience, adherence and efficacy. The safety and efficacy of the online prehabilitation program will need to be determined in a larger randomized controlled trial. Full article
(This article belongs to the Special Issue Preoperative Optimisation in Patients Undergoing Cancer Surgery)
18 pages, 547 KiB  
Article
Colorectal Cancer Surgery: Influence of Psychosocial Factors
by Regina Moldes-Moro and María José de Dios-Duarte
Cancers 2023, 15(16), 4140; https://doi.org/10.3390/cancers15164140 - 17 Aug 2023
Cited by 3 | Viewed by 1464
Abstract
(1) Background: In the treatment of colorectal cancer, it is important to consider different psychosocial factors. Our first objective was to measure the levels of perceived stress in subjects diagnosed with colorectal cancer awaiting potentially curative surgery. Also, we aimed to analyse what [...] Read more.
(1) Background: In the treatment of colorectal cancer, it is important to consider different psychosocial factors. Our first objective was to measure the levels of perceived stress in subjects diagnosed with colorectal cancer awaiting potentially curative surgery. Also, we aimed to analyse what coping styles these patients used, how they perceived their illness, and the subsequent influence of these factors on their levels of stress. (2) Methods: Stress, coping styles and illness perception were assessed in a sample of 107 patients. The instruments used were the Perceived Stress Scale (PSS-14), the Stress Coping Questionnaire (SCQ) and the Brief Illness Perception Questionnaire (BIPQ-R). (3) Results: Patients using active coping styles have lower levels of perceived stress (p = 0.000; p = 0.002) than patients making use of passive coping styles (p = 0.000; p = 0.032; p = 0.001). A multi-linear regression model found that the perception of illness and the use of the negative approach coping style (p = 0.000; p = 0.001) influence an increase in perceived stress, and that a decrease in stress levels was influenced by the problem solving coping style (p = 0.001). (4) Conclusions: Based on our results, we recommend preventive interventions in care patients undergoing colorectal cancer surgery. Full article
(This article belongs to the Special Issue Preoperative Optimisation in Patients Undergoing Cancer Surgery)
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10 pages, 826 KiB  
Article
Feasibility, Reliability, and Safety of Remote Five Times Sit to Stand Test in Patients with Gastrointestinal Cancer
by Daniel Steffens, Natasha C. Pocovi, Jenna Bartyn, Kim Delbaere, Mark J. Hancock, Cherry Koh, Linda Denehy, Kimberley S. van Schooten, Michael Solomon and on behalf of the Priority Trial Collaboration
Cancers 2023, 15(9), 2434; https://doi.org/10.3390/cancers15092434 - 24 Apr 2023
Cited by 4 | Viewed by 2019
Abstract
Background: To determine the feasibility, reliability, and safety of the remote five times sit to stand test (5STS) test in patients with gastrointestinal cancer. Methods: Consecutive adult patients undergoing surgical treatment for lower gastrointestinal cancer at a major referral hospital in Sydney between [...] Read more.
Background: To determine the feasibility, reliability, and safety of the remote five times sit to stand test (5STS) test in patients with gastrointestinal cancer. Methods: Consecutive adult patients undergoing surgical treatment for lower gastrointestinal cancer at a major referral hospital in Sydney between July and November 2022 were included. Participants completed the 5STS test both face-to-face and remotely, with the order randomised. Outcomes included measures of feasibility, reliability, and safety. Results: Of fifty-five patients identified, seventeen (30.9%) were not interested, one (1.8%) had no internet coverage, and thirty-seven (67.3%) consented and completed both 5STS tests. The mean (SD) time taken to complete the face-to-face and remote 5STS tests was 9.1 (2.4) and 9.5 (2.3) seconds, respectively. Remote collection by telehealth was feasible, with only two participants (5.4%) having connectivity issues at the start of the remote assessment, but not interfering with the tests. The remote 5STS test showed excellent reliability (ICC = 0.957), with limits of agreement within acceptable ranges and no significant systematic errors observed. No adverse events were observed within either test environment. Conclusions: Remote 5STS for the assessment of functional lower extremity strength in gastrointestinal cancer patients is feasible, reliable, and safe, and can be used in clinical and research settings. Full article
(This article belongs to the Special Issue Preoperative Optimisation in Patients Undergoing Cancer Surgery)
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11 pages, 814 KiB  
Article
Impact of Surgical Care Bundle on Surgical Site Infection after Non-Reconstructive Breast Cancer Surgery: A Single-Centre Retrospective Comparative Cohort Study
by Kian Chin, Fredrik Wärnberg, Anikó Kovacs and Roger Olofsson Bagge
Cancers 2023, 15(3), 919; https://doi.org/10.3390/cancers15030919 - 1 Feb 2023
Cited by 3 | Viewed by 2391
Abstract
Background: Surgical-site infections (SSIs) are the commonest cause of healthcare-related infections. Although a surgical care bundle (SCB), defined as a group of preventative measures, is effective in reducing SSIs, it has not been well documented in breast cancer surgery. We aimed to investigate [...] Read more.
Background: Surgical-site infections (SSIs) are the commonest cause of healthcare-related infections. Although a surgical care bundle (SCB), defined as a group of preventative measures, is effective in reducing SSIs, it has not been well documented in breast cancer surgery. We aimed to investigate the impact of SCB on SSI. Methods: A single-centre retrospective comparative cohort study between 2016 and 2020 was carried out. An SCB including eight different measures was implemented in October 2018 at Sahlgrenska University Hospital, Sweden. Patients who underwent non-reconstructive breast cancer surgery were included for analysis. The primary endpoint was SSI within 30 days after surgery. Results: Overall, 10.4% of patients (100/958) developed SSI. After SCB implementation, the overall SSI rate reduced from 11.8% to 8.9% (p = 0.15). The largest SSI rate reduction was seen in the subgroup that underwent breast conservation and sentinel lymph node biopsy (SLNB), from 18.8% to 9.8% (p = 0.01). In this multivariable analysis adjusting for patient and treatment factors, the implementation of SCB resulted in a statistically significant reduction in SSI risk (OR 0.63, 95% CI 0.40–0.99, p = 0.04). Conclusions: The implementation of a SCB could reduce the incidence of SSI in breast cancer surgery. Full article
(This article belongs to the Special Issue Preoperative Optimisation in Patients Undergoing Cancer Surgery)
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