Introduction There is no consensus among colorectal surgeons as to whether preoperative exercise is beneficial in the management of colorectal cancer patients. Research has shown higher rates of postoperative complications in patients who are less fit.1Agreement needs to be sought on whether improving fitness via exercise should be a part of preoperative care. The Delphi process is an iterative process designed to refine opinions on a subject, until consensus agreement is reached within an expert group.
Method We performed a 3 stage electronic Delphi survey with a group of consultant colorectal surgeons. Statements regarding the importance, benefits, risks and feasibility of preoperative exercise were scored on a 5 point Likert scale. Simple descriptive statistics were used to analyse the results. Statements achieving >80% agreement were taken as consensus, those achieving >80% disagreement were removed and those in between were revised in the following round. The process ended with a group of statements which achieved consensus.
Results 34 statements were including in the first round of the Delphi survey. After 3 rounds 22 statements were accepted as consensus opinion, 7 statements were rejected and 7 statements did not reach consensus. It was agreed that preoperative exercise training should form part of preoperative care, was beneficial to many aspects of health and would be supported by surgeons in their own practice. Personally tailored and suitably monitored programmes were not thought to pose significant risk to patients. There was no consensus reached on the strength of current available evidence for the benefits of preoperative exercise or whether it would be possible to deliver these programmes in participant’s institutions at present.
Conclusion This work is the first to produce a set of statements on which expert consensus opinion has been agreed regarding preoperative exercise in colorectal cancer patients. Future work, informed by this study, will design interventions to produce rapid improvements in fitness before surgery.
Disclosure of interest None Declared.
M. a West, M. G. Parry, D. Lythgoe, C. P. Barben, G. J. Kemp, M. P. W. Grocott, and S. Jack, Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery. Br J Surg.2014;101(9):1166–72
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