Preoperative Walking Capacity Indirectly Relates to Decreased Postoperative Complications in Patients with Gastrointestinal Cancer

OBJECTIVES: Postoperative complications (PCs) in patients with gastrointestinal cancer (GIC) lead to reduced lifespan and poor quality of life. The aim of this study was to investigate the correlation between preoperative exercise-related factors, together with other contributory factors, and the frequency of PCs in patients with GIC. METHODS: This was a cross-sectional, three-institution study. We enrolled 299 patients who were scheduled for elective surgery for GIC (182 men and 117 women; age, 65.7 ± 11.0 years). PCs were graded using the Clavien–Dindo classification based on the medical records 1 month postoperatively. Exercise-related factors (the skeletal muscle index, the isometric knee extension torque, and the 6-min walk test [6 MWT] distance) were measured before surgery. Based on previous studies of factors contributing to complications, data on age, sex, clinical cancer stage, comorbidities, neoadjuvant therapy, type of surgery, surgery duration, blood loss, blood transfusion, laboratory data, respiratory function, body mass index, and visceral fat area were collected. RESULTS: The frequency of PCs was positively correlated with surgery duration (β=0.427) and C-reactive protein (CRP) level on postoperative day 3 (β=0.189). The 6 MWT was negatively correlated with the frequency of PCs through CRP level on postoperative day 3 (β=–0.035). This model demonstrated an acceptable fit to the data (goodness-of-fit index, 0.979; adjusted goodness-of-fit index, 0.936; comparative fit index, 0.944; and root mean square error of approximation, 0.076). CONCLUSIONS: Preoperative walking capacity was correlated with PCs in patients undergoing GIC surgery. Prevention of PCs in patients with GIC requires the monitoring of both surgical parameters and postoperative inflammation.