Exercise in primary care after robot-assisted radical cystectomy for urinary bladder cancer – effects on postoperative complications: a secondary analysis of a randomised controlled trial

Authors

  • Andrea Porserud Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden https://orcid.org/0000-0001-9144-7905
  • Markus Aly Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Theme Cancer, Patient Area Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden https://orcid.org/0000-0002-7602-9198
  • Hanna Steinertz Department of Physiotherapy, Danderyd Hospital, Danderyd, Sweden
  • Elisabeth Rydwik Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Women’s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden https://orcid.org/0000-0003-0550-1675
  • Maria Hagströmer Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden; Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden https://orcid.org/0000-0002-4607-8677

DOI:

https://doi.org/10.2340/sju.v59.42589

Keywords:

Abdominal surgery, hernia, infection, physical activity, readmission, rehabilitation, robotic radical cystectomy with intracorporeal reconstruction

Abstract

Objective: An exercise programme in primary care soon after radical cystectomy for urinary bladder cancer was previously evaluated regarding its effects on physical function. A secondary aim, presented herein, was to evaluate the programme in terms of its effect on postoperative complications.

Materials and methods: Patients who were planned for robot-assisted radical cystectomy for urinary bladder cancer at Karolinska University Hospital between September 2019 and October 2022 were invited to participate. At discharge from hospital, they were randomised to intervention group including aerobic and resistance exercises with physiotherapist in primary care twice a week for 12 weeks and daily walks, or to unsupervised home-based exercise including daily walks. Readmission rates between 30 and 90 days after discharge, and complications according to Clavien Dindo were collected from the medical records and analysed.

Results: Ninety patients were randomised, with a mean (SD) age of 72 (9) years. Readmission rates between 30 and 90 days showed no difference between the groups. For readmitted patients, the intervention group had significantly fewer complications reported as Clavien Dindo grade 2 compared to the control group. 

Conclusion: An exercise programme in primary care soon after robot-assisted radical cystectomy appears to be safe for patients, as measured by hospital readmission rates. 

Trial registration: Clinical Trials (NCT03998579).

Downloads

Download data is not yet available.

References

Cicione A, De Nunzio C, Lombardo R, et al. Complications and quality of life of ileal conduit, orthotopic neobladder and ureterocutaneostomy: systematic review of reports using the Clavien-Dindo Classification. Minerva Urol Nefrol. 2020;72(4):408–419. https://doi.org/10.23736/S0393-2249.20.03641-3 DOI: https://doi.org/10.23736/S0393-2249.20.03641-3

Zhou Y, Li R, Liu Z, et al. The effect of the enhanced recovery after surgery program on radical cystectomy: a meta-analysis and systematic review. Front Surgery. 2023;10:1101098. https://doi.org/10.3389/fsurg.2023.1101098 DOI: https://doi.org/10.3389/fsurg.2023.1101098

Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3):292–298. https://doi.org/10.1001/jamasurg.2016.4952 DOI: https://doi.org/10.1001/jamasurg.2016.4952

Narang SK, Alam NN, Campain NJ, et al. Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review. Hernia. 2017;21(2):163–175. https://doi.org/10.1007/s10029-016-1561-z DOI: https://doi.org/10.1007/s10029-016-1561-z

Novara G, Catto JW, Wilson T, et al. Systematic review and cumulative analysis of perioperative outcomes and complications after Robot-assisted radical cystectomy. Eur Urol. 2015;67(3):376–401. https://doi.org/10.1016/j.eururo.2014.12.007 DOI: https://doi.org/10.1016/j.eururo.2014.12.007

Jensen BT, Lauridsen SV, Jensen JB. Optimal delivery of follow-up care after radical cystectomy for bladder cancer. Res Rep Urol. 2020;12:471–486. https://doi.org/10.2147/RRU.S270240 DOI: https://doi.org/10.2147/RRU.S270240

Lin HS, Watts JN, Peel NM, et al. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157. https://doi.org/10.1186/s12877-016-0329-8 DOI: https://doi.org/10.1186/s12877-016-0329-8

Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: Consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375–2390. https://doi.org/10.1249/MSS.0000000000002116 DOI: https://doi.org/10.1249/MSS.0000000000002116

Cormie P, Zopf EM, Zhang X, et al. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev. 2017;39(1):71–92. https://doi.org/10.1093/epirev/mxx007 DOI: https://doi.org/10.1093/epirev/mxx007

Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126–131.

Green DJ, Spence A, Halliwill JR, et al. Exercise and vascular adaptation in asymptomatic humans. Exp Physiol. 2011;96(2):57–70. https://doi.org/10.1113/expphysiol.2009.048694 DOI: https://doi.org/10.1113/expphysiol.2009.048694

Kasapis C, Thompson PD. The effects of physical activity on serum C-reactive protein and inflammatory markers: a systematic review. J Am Coll Cardiol. 2005;45(10):1563–1569. https://doi.org/10.1016/j.jacc.2004.12.077 DOI: https://doi.org/10.1016/j.jacc.2004.12.077

Scott MJ, Baldini G, Fearon KC, et al. Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 1: pathophysiological considerations. Acta Anaesthesiol Scand. 2015;59(10):1212–1231. https://doi.org/10.1111/aas.12601 DOI: https://doi.org/10.1111/aas.12601

Schulz GB, Grimm T, Buchner A, et al. Benefits and complications during the stay at an early rehabilitation facility after radical cystectomy and orthotopic ileum neobladder reconstruction. Urol Int. 2019;103(3):350–356. https://doi.org/10.1159/000502657 DOI: https://doi.org/10.1159/000502657

Götte M, Bahlburg H, Butea-Bocu MC, et al. Complications in the early recovery period after radical cystectomy-real data from impartial inpatient rehabilitation. Clin Genitourin Cancer. 2022;20(5):e424–e431. https://doi.org/10.1016/j.clgc.2022.05.008 DOI: https://doi.org/10.1016/j.clgc.2022.05.008

Porserud A, Karlsson P, Aly M, et al. Effects of an exercise intervention in primary care after robot-assisted radical cystectomy for urinary bladder cancer: a randomised controlled trial. BMC Cancer. 2024;24(1):891. https://doi.org/10.1186/s12885-024-12647-2 DOI: https://doi.org/10.1186/s12885-024-12647-2

Porserud A, Karlsson P, Rydwik E, et al. The CanMoRe trial – evaluating the effects of an exercise intervention after robotic-assisted radical cystectomy for urinary bladder cancer: the study protocol of a randomised controlled trial. BMC Cancer. 2020;20(1):805. https://doi.org/10.1186/s12885-020-07140-5 DOI: https://doi.org/10.1186/s12885-020-07140-5

Hosseini A, Adding C, Nilsson A, et al. Robotic cystectomy: surgical technique. BJU Int. 2011;108(6 Pt 2):962–968. https://doi.org/10.1111/j.1464-410X.2011.10566.x DOI: https://doi.org/10.1111/j.1464-410X.2011.10566.x

Porserud A, Aly M, Nygren-Bonnier M, et al. Objectively measured mobilisation is enhanced by a new behaviour support tool in patients undergoing abdominal cancer surgery. Eur J Surg Oncol. 2019;45(10):1847–1853. https://doi.org/10.1016/j.ejso.2019.04.013 DOI: https://doi.org/10.1016/j.ejso.2019.04.013

Porserud A, Lundberg M, Eriksson J, et al. Like I said, I would not have likely gotten up otherwise: patient experiences of using an Activity Board after abdominal cancer surgery. Disabil Rehabil. 2022;45(6):1022–1029. https://doi.org/10.1080/09638288.2022.2048097 DOI: https://doi.org/10.1080/09638288.2022.2048097

Karlsson P, Porserud A, Hagströmer M, et al. Healthcare professionals’ experiences of using the Activity Board as a tool for postoperative mobilization in patients after abdominal cancer surgery. J Cancer Rehabil. 2022;5:90–97.

Thompson MJ. Parastomal hernia: incidence, prevention and treatment strategies. Br J Nurs. 2008;17(2):S16, s8–s20. https://doi.org/10.12968/bjon.2008.17.Sup1.28145 DOI: https://doi.org/10.12968/bjon.2008.17.Sup1.28145

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae DOI: https://doi.org/10.1097/01.sla.0000133083.54934.ae

Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2 DOI: https://doi.org/10.1097/SLA.0b013e3181b13ca2

Borza T, Jacobs BL, Montgomery JS, et al. No differences in population-based readmissions after open and Robotic-assisted radical cystectomy: implications for post-discharge care. Urology. 2017;104:77–83. https://doi.org/10.1016/j.urology.2017.01.042 DOI: https://doi.org/10.1016/j.urology.2017.01.042

Cacciamani GE, Medina L, Lin-Brande M, et al. Timing, patterns and predictors of 90-day readmission rate after Robotic radical cystectomy. J Urol. 2021;205(2):491–499. https://doi.org/10.1097/JU.0000000000001387 DOI: https://doi.org/10.1097/JU.0000000000001387

Clifford TG, Katebian B, Van Horn CM, et al. Urinary tract infections following radical cystectomy and urinary diversion: a review of 1133 patients. World J Urol. 2018;36(5):775–781. https://doi.org/10.1007/s00345-018-2181-2 DOI: https://doi.org/10.1007/s00345-018-2181-2

Ellis JL, Dalimov Z, Chew L, et al. Preoperative optimization of the radical cystectomy patient: current state and future directions. J Surg Oncol. 2024;129(1):138–144. https://doi.org/10.1002/jso.27546 DOI: https://doi.org/10.1002/jso.27546

Ghoreifi A, Allgood E, Whang G, et al. Risk factors and natural history of parastomal hernia after radical cystectomy and ileal conduit. BJU Int. 2022;130(3):381–388. https://doi.org/10.1111/bju.15658 DOI: https://doi.org/10.1111/bju.15658

Additional Files

Published

2024-12-18

How to Cite

Porserud, A., Aly, M., Steinertz, H., Rydwik, E., & Hagströmer, M. (2024). Exercise in primary care after robot-assisted radical cystectomy for urinary bladder cancer – effects on postoperative complications: a secondary analysis of a randomised controlled trial. Scandinavian Journal of Urology, 59, 193–199. https://doi.org/10.2340/sju.v59.42589

Issue

Section

Original research article