Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2022 Jul;92(7-8):1658-1667. doi: 10.1111/ans.17577. Epub 2022 Mar 6.
There is clinical uncertainty regarding an association between preoperative functional capacity of cancer patients, and postoperative outcomes. The aim of this systematic review and meta-analysis is to investigate whether poor performance on preoperative six-minute walk test (6MWT) or five-times sit to stand test (5STS) is associated with worse postoperative complication rates and prolonged length of hospital stay (LOS) in cancer patients.
An electronic search was performed from earliest available record to 26th February 2021 in MEDLINE, Embase and AMED. Studies investigating the association between preoperative physical function (measured using either 6MWT or 5STS) and postoperative outcomes (complications and LOS) in patients with gastrointestinal, abdominal and pelvic cancers were included. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Where possible, summary odds ratios (OR) or mean differences (MD), and 95% confidence intervals (CI) were calculated using random-effect models.
Five studies (379 patients) were included, of which none utilized the 5STS. Overall, studies were rated as having low to moderate risk of bias. Higher preoperative performance on the 6MWT (≥400 m) was associated with low grade postoperative complications (OR = 0.38; 95% CI = 0.15-0.95) but was not associated with a shorter LOS (MD = 3.29; 95%CI = -1.07-7.66).
The available evidence suggests that in cancer patients, a higher preoperative functional capacity may be associated with reduced postoperative complications. Conversely, there is no significant association between preoperative function and LOS. Further high-quality studies are needed in this area, including studies involving 5STS.
癌症患者术前功能能力与术后结局之间的关联存在临床不确定性。本系统评价和荟萃分析的目的是调查术前 6 分钟步行试验（6MWT）或 5 次坐立试验（5STS）表现不佳是否与癌症患者术后并发症发生率增加和住院时间延长（LOS）相关。
从最早可获得的记录到 2021 年 2 月 26 日，在 MEDLINE、Embase 和 AMED 中进行了电子检索。纳入研究调查了术前身体功能（使用 6MWT 或 5STS 测量）与胃肠道、腹部和盆腔癌症患者术后结局（并发症和 LOS）之间的关系。使用预后研究质量（QUIPS）工具评估偏倚风险。在可能的情况下，使用随机效应模型计算汇总优势比（OR）或均数差值（MD）和 95%置信区间（CI）。
共纳入 5 项研究（379 名患者），其中没有一项研究使用 5STS。总体而言，研究被评为低至中度偏倚风险。术前 6MWT 表现较好（≥400m）与低等级术后并发症相关（OR=0.38；95%CI=0.15-0.95），但与 LOS 缩短无关（MD=3.29；95%CI=-1.07-7.66）。
现有证据表明，在癌症患者中，术前功能能力较高可能与术后并发症减少相关。相反，术前功能与 LOS 之间没有显著关联。在这一领域需要进一步开展高质量的研究，包括涉及 5STS 的研究。
