{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:26:49Z","timestamp":1790746009335,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Colorectal Disease"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Locally advanced pelvic malignancies, such as colorectal and anal cancers, can only be cured through multimodal cancer treatment including multi\u2010visceral exenterative resections, which carry a high mortality and morbidity risk. Despite strong predictive abilities in other cancer cohorts, the combined prognostic value of body composition and cardiopulmonary exercise testing (CPET) for major in\u2010hospital morbidity in patients undergoing exenterative surgery for advanced pelvic cancers has not been evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A locally advanced colorectal and anal cancer cohort was derived from a prospectively maintained quaternary database. CPET was undertaken preoperatively, according to national guidelines. Skeletal muscle index (SMI) and radiation attenuation (SM\u2010RA) were obtained from analysing L3 slices from preoperative computed tomography scans using SliceOmatic 5.0 and classified using predefined thresholds. Major morbidity was defined as Clavien\u2010Dindo classification 3a or greater.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 247 patients (58% male, median age 60\u2009years), 62.4% and 35.5% had locally advanced or recurrent disease respectively. Physical fitness variables were significantly reduced in low SMI or low SM\u2010RA patients. In multivariate linear regression, SMI was strongly predictive of oxygen uptake at the anaerobic threshold (B\u2009=\u20090.013,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and at peak (B\u2009=\u20090.015,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). 17.3% of all patients experienced a major postoperative complication. In multivariate analysis, reduced peak power output (&lt;1.5\u2009W\u2009kg\n                      <jats:sup>\u22121<\/jats:sup>\n                      ) was significantly associated with an increased risk of postoperative major morbidity (OR\u2009=\u20092.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.012).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CPET may be predictive of in\u2010hospital major morbidity in this cohort. The association of CPET with body composition necessitates further evaluation and external validation in a larger patient cohort, specifically interrogating their combined role in morbidity prediction and as a target for prehabilitation interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/codi.70298","type":"journal-article","created":{"date-parts":[[2025,11,19]],"date-time":"2025-11-19T04:03:38Z","timestamp":1763525018000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Physical fitness and body composition assessments in advanced cancer patients undergoing exenterative surgery \u2013 A pilot cohort study"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4853-5446","authenticated-orcid":false,"given":"Marina","family":"Looby","sequence":"first","affiliation":[{"name":"Academic Surgery, Cancer Sciences, Faculty of Medicine University of Southampton  Southampton UK"},{"name":"Southampton Complex Cancer and Exenteration Team (SCCET) University Hospital Southampton  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis","family":"Matthews","sequence":"additional","affiliation":[{"name":"NIHR Biomedical Research Centre, Perioperative Medicine and Prehabilitation Theme University Hospital Southampton  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles T.","family":"West","sequence":"additional","affiliation":[{"name":"Academic Surgery, Cancer Sciences, Faculty of Medicine University of Southampton  Southampton UK"},{"name":"Southampton Complex Cancer and Exenteration Team (SCCET) University Hospital Southampton  Southampton UK"},{"name":"NIHR Biomedical Research Centre, Perioperative Medicine and Prehabilitation Theme University Hospital Southampton  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kashuf","family":"Khan","sequence":"additional","affiliation":[{"name":"Academic Surgery, Cancer Sciences, Faculty of Medicine University of Southampton  Southampton UK"},{"name":"Southampton Complex Cancer and Exenteration Team (SCCET) University Hospital Southampton  Southampton UK"},{"name":"NIHR Biomedical Research Centre, Perioperative Medicine and Prehabilitation Theme University Hospital Southampton  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gillian","family":"Ansell","sequence":"additional","affiliation":[{"name":"Southampton Complex Cancer and Exenteration Team (SCCET) University Hospital Southampton  Southampton UK"},{"name":"Department of Anaesthesia and Perioperative Medicine University Hospital Southampton  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Donovan","sequence":"additional","affiliation":[{"name":"Southampton Complex Cancer and Exenteration Team (SCCET) University Hospital Southampton  Southampton UK"},{"name":"Department of Anaesthesia and Perioperative Medicine University Hospital Southampton  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Wood","sequence":"additional","affiliation":[{"name":"Southampton Complex Cancer and Exenteration Team (SCCET) University Hospital Southampton  Southampton UK"},{"name":"Department of Anaesthesia and Perioperative Medicine University Hospital Southampton  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Tapley","sequence":"additional","affiliation":[{"name":"Southampton Complex Cancer and Exenteration Team (SCCET) University Hospital Southampton  Southampton UK"},{"name":"Department of Anaesthesia and Perioperative Medicine University Hospital Southampton  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhys","family":"Lewis","sequence":"additional","affiliation":[{"name":"Southampton Complex Cancer and Exenteration Team (SCCET) University Hospital Southampton  Southampton UK"},{"name":"Department of Anaesthesia and Perioperative Medicine University Hospital Southampton  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Stoddard","sequence":"additional","affiliation":[{"name":"Southampton Complex Cancer and Exenteration Team (SCCET) University Hospital Southampton  Southampton UK"},{"name":"Department of Anaesthesia and Perioperative Medicine University Hospital Southampton  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P. 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