Motoki Nagaya

Preoperative 6-minute walk distance accurately predicts postoperative complications after operations for hepato-pancreato-biliary cancer

BACKGROUND Operation for hepato‐pancreato‐biliary cancer is among the most invasive open abdominal operations, with a high postoperative morbidity and mortality rate. The purpose of the present study is to investigate whether a preoperative 6‐minute walk distance can predict major postoperative complications after operation for hepato‐pancreato‐biliary diseases. METHODS A total of 81 participants who underwent pancreaticoduodenectomy, major hepatectomy with extrahepatic bile duct resection, or hepatopancreatoduodenectomy were included. The 6‐minute walk distance was performed within 1 week before operation. Patients were categorized into 2 groups based on surgical complications: Clavien‐Dindo grade <3 and Clavien‐Dindo grade ≥3. Clinical differences between the 2 groups were analyzed. Multivariate logistic regression analysis was performed to identify risk factors for postoperative complications that were categorized as Clavien‐Dindo grade ≥3. RESULTS The multiple logistic regression model revealed a significant correlation between major postoperative complications and preoperative low 6‐minute walk distance, low body mass index, and major blood loss. In patients with 6‐minute walk distance <400 m (1,312 feet), the Clavien‐Dindo grade was considerably greater than patients with ≥400 m. CONCLUSION The 6‐minute walk distance is useful in identifying patients with a greater chance of developing major postoperative complications after surgery for hepato‐pancreato‐biliary cancer.

Preoperative six-minute walk distance is associated with pneumonia after lung resection

OBJECTIVES Little is known about the relationship between preoperative physical fitness and postoperative pneumonia after lung resection. We examined the association between preoperative 6-min walk distance (6MWD) and postoperative pneumonia. METHODS A retrospective study was conducted on patients with malignant lung tumours who were scheduled to undergo lung resection at Nagoya University Hospital from January 2014 to December 2015. Preoperative pulmonary function tests and the 6-min walk test were assessed. A logistic regression model and receiver operating characteristic curves were used to analyse clinical variables and compare the performance on 6MWD, forced expiratory volume in 1 s and diffusion capacity of the lung for carbon monoxide. RESULTS The data from a total of 321 patients including 283 with primary lung cancer and 38 with metastatic lung tumours were analysed. Pneumonia developed in 13 patients and caused longer hospital stays after surgery. The preoperative 6MWD of patients with pneumonia was significantly lower than that without pneumonia (425 vs 500 m, P = 0.002). In receiver operating characteristic analysis, 6MWD ≤ 450 m was a threshold for predicting postoperative pneumonia with 69.2% sensitivity and 71.1% specificity. A 6MWD ≤ 450 m, forced expiratory volume in 1 s <80% of the predicted value, diffusion capacity of the lung for carbon monoxide <80% of the predicted value, serum albumin <3.5 g/dl and blood loss during surgery ≥200 g were significantly associated with postoperative pneumonia in a logistic model. CONCLUSIONS Preoperative 6MWD was significantly associated with postoperative pneumonia in patients who underwent lung resection for malignancies.

Changes in Muscle Strength and Six-Minute Walk Distance Before and After Living Donor Liver Transplantation

BACKGROUND Impaired exercise capacity and muscle weakness are important characteristics of liver transplantation recipients. Perioperative rehabilitation has been introduced to promote early mobilization of patients and to prevent postoperative pulmonary complications. However, it is unknown how physical status recovers during the hospital stay after a liver transplant. The purpose of this study was to evaluate the changes in clinical indicators that represent the functional exercise capacity and muscle strength before and after living donor liver transplantation (LDLT). METHODS We retrospectively reviewed 21 consecutive patients who underwent LDLT with perioperative rehabilitation from April 2014 to December 2015. Twelve patients who were tested for 6-minute walk distance, hand-grip strength, and isometric knee extensor muscle strength before and 4 weeks after LDLT were enrolled. RESULTS At the preoperative baseline, the 6-minute walk distance significantly correlated with the Model for End-stage Liver Disease score and pulmonary functions (vital capacity, forced vital capacity, and forced expiratory volume in 1 second of predictive values). Comparisons between the preoperative and postoperative values revealed significant decreases in weight, Barthel Index, hand-grip strength, and isometric knee extensor muscle strength. Changes in hand-grip strength and isometric knee extensor muscle strength after LDLT correlated with the preoperative Model for End-stage Liver Disease score. CONCLUSIONS Physical functional status had not been fully recovered 4 weeks after LDLT. Further investigation regarding developing a strategy for prevention of muscle atrophy before LDLT and recovery of physical fitness after LDLT would be helpful.

Post-operative delayed ambulation after thymectomy is associated withpre-operative six-minute walk distance

Abstract Objective: Delayed post-operative ambulation is a risk of post-operative complications and increases overall healthcare costs. We investigated pre-operative and intraoperative variables associated with delayed ambulation in patients who underwent thymectomy. Methods: A total of 57 consecutive patients undergoing thymectomy were included in this study. Pre-operative functional exercise capacity was evaluated by six-minute walk distance. Ambulation was considered to be delayed if the patient could not walk the ward on post-operative day 1. Binary logistic regression analysis was performed to clarify the factors associated with delayed ambulation. Results: Pre-operative six-minute walk distance was the only significant variable that was associated with delayed ambulation. The area under the receiver operating characteristic curve for predicting delayed ambulation was 0.684 (95% confidential interval: 0.546–0.823, p = 0.017), and the optimal discriminatory pre-operative six-minute walk distance value was 498 m. Post-operative hospital stay was significantly longer in patients with low six-minute walk distance (<498 m) than those with high six-minute walk distance (≥498 m). In contrast, the presence of myasthenia gravis or adjuvant chemoradiotherapy was not associated with delayed ambulation. Conclusions: Our results suggest that low pre-operative six-minute walk distance is associated with delayed post-operative ambulation and longer post-operative hospital stay in patients who underwent thymectomy. Implications for rehabilitation The predictors for delayed ambulation after thymectomy are not fully investigated. The presence of myasthenia gravis was not associated with delayed ambulation. Low pre-operative six-minute walk distance was associated with delayed ambulation.

Development of rehabilitation support system for lower limbs for recovery and quantitative evaluation of proprioception

Proprioception should be necessary for the trunk balance and skillful movement. However, proprioception deteriorates due to aging and spinal cord injury. Training for the recovery of proprioception is required because of the ADL and prevention of overturning. We have developed a new rehabilitation support system for “sensory training”. The purpose of this study is to perform clinical trials with 2 patients by using our system and discuss the results of clinical trials by analyzing the experimental data. In our system, video games are prepared as test programs for the proposed system. The measurements are performed one time before the operation and once or more until subjects are discharged from the hospital after the operation. In experiments, as the comparison studies, conventional quantitative evaluation tests, namely gravicorder test and 10 meter walking test are performed. As a result, this system plays a role of helping the patient with deteriorated proprioception to control lower limb as useful training tool based on the vision information feedback.

Preoperative evaluation of six-minute walk test in patients with malignant pleural mesothelioma

Abstract Objective: Surgical treatment of malignant pleural mesothelioma (MPM) is accompanied by high morbidity and mortality. The aim of this retrospective study was to characterize preoperative physical fitness and relate it to pulmonary functions, oxygenation, and postoperative outcomes in patients with MPM who underwent surgical resection with perioperative rehabilitation. Methods: A total of 18 patients were retrospectively reviewed. Preoperative exercise capacity was evaluated by the 6-min walk test (6MWT). Oxygen saturation of a peripheral artery (SpO2) was measured during the 6MWT. Results: The 6-min walk distance was significantly correlated with inspiratory capacity and % of predicted diffusing capacity of the lung for carbon monoxide. The minimum SpO2 during the 6MWT correlated with % of predicted vital capacity and total lung capacity and postoperative days of extubation. There were a total of 14 major complications in six patients. The incidence of major complications was associated with longer stays in intensive care unit and hospital but not with preoperative physical status or pulmonary functions. Conclusion: Our results indicate that the 6MWT is useful to assess preoperative physical status in patients with resectable MPM.

Combination Treatment of Perioperative Rehabilitation and Psychoeducation Undergoing Thoracic Surgery

Postoperative pulmonary complications are a risk associated with thoracic surgery. However, there have been few reports on cases at high risk of postoperative complications. Cancer patients often have negative automatic thoughts about illness, and these negative automatic thoughts are associated with reduced health behavior and physical activity. This case series demonstrates the successful combination treatment of perioperative rehabilitation and psychoeducation for negative automatic thoughts in two cancer patients who underwent thoracic surgery. One patient underwent pneumonectomy with laryngeal recurrent nerve paralysis; the other patient, who had a history of recurrent hepatic encephalopathy and dialysis, underwent S6 segmentectomy. Both patients had negative automatic thoughts about cancer-related stress and postoperative pain. The physical therapists conducted a perioperative rehabilitation program in which the patients were educated to replace their maladaptive thoughts with more adaptive thoughts. After rehabilitation, the patients had improved adaptive thoughts, increased physical activity, and favorable recovery without pulmonary complications. This indicates that the combination treatment of perioperative rehabilitation and psychoeducation was useful in two thoracic cancer surgery patients. The psychoeducational approach should be expanded to perioperative rehabilitation of patients with cancer.