Explore the vast range of titles available.

BackgroundNeoadjuvant therapy reduces fitness, muscle mass, and quality of life (QOL). For patients undergoing chemotherapy and surgery for esophagogastric cancer, maintenance of fitness is paramount. This study investigated the effect of exercise and psychological prehabilitation on anaerobic threshold (AT) at cardiopulmonary exercise testing (CPET). Secondary endpoints included peak oxygen uptake (peak VO2), skeletal muscle mass, QOL, and neoadjuvant therapy completion.MethodsThis parallel-arm randomized controlled trial assigned patients with locally advanced esophagogastric cancer to receive prehabilitation or usual care. The 15-week program comprised twice-weekly supervised exercises, thrice-weekly home exercises, and psychological coaching. CPET was performed at baseline, 2 weeks after neoadjuvant therapy, and 1 week preoperatively. Skeletal muscle cross-sectional area at L3 was analyzed on staging and restaging computed tomography. QOL questionnaires were completed at baseline, mid-neoadjuvant therapy, at restaging laparoscopy, and postoperatively at 2 weeks, 6 weeks and 6 months.ResultsFifty-four participants were randomized (prehabilitation group, n = 26; control group, n = 28). No difference in AT between groups was observed post-neoadjuvant therapy. Prehabilitation resulted in an attenuated peak VO2 decline {−0.4 [95% confidence interval (CI) −0.8 to 0.1] vs. −2.5 [95% CI −2.8 to −2.2] mL/kg/min; p = 0.022}, less muscle loss [−11.6 (95% CI −14.2 to −9.0) vs. −15.6 (95% CI −18.7 to −15.4) cm2/m2; p = 0.049], and improved QOL. More prehabilitation patients completed neoadjuvant therapy at full dose [prehabilitation group, 18 (75%) vs. control group, 13 (46%); p = 0.036]. No adverse events were reported.ConclusionsThis study has demonstrated some retention of cardiopulmonary fitness (peak VO2), muscle, and QOL in prehabilitation subjects. Further large-scale trials will help determine whether these promising findings translate into improved clinical and oncological outcomes.Trial Registration ClinicalTrials.gov NCT02950324.

Background Breast cancer (BC) is a significant health challenge, ranking as the second leading cause of cancer-related death and the primary cause of mortality among women aged 45 to 55. Early detection is crucial for optimal prognosis. Among various treatment options available for cancer, chemotherapy remains the predominant approach. However, its patient-friendliness is hindered by cytotoxicity, adverse effects, multi-drug resistance, potential for recurrence, and high costs. This review explores extensively studied phytomolecules, elucidating their molecular mechanisms. It also emphasizes the importance of combination therapy, highlighting recent advancements in the exploration of diverse drug delivery systems and novel routes of administration. The regulatory considerations are crucial in translating these approaches into clinical practices. Results Consequently, there is growing interest in exploring the relationship between diet, cancer, and complementary and alternative medicine (CAM) in cancer chemotherapy. Phytochemicals like berberine, curcumin, quercetin, lycopene, sulforaphane, resveratrol, epigallocatechin gallate, apigenin, genistein, thymoquinone have emerged as promising candidates due to their pleiotropic actions on target cells through multiple mechanisms with minimal toxicity effects. This review focuses on extensively studied phytomolecules, elucidating their molecular mechanisms. It also emphasizes the importance of combination therapy, highlighting recent advancements in the exploration of diverse drug delivery systems and novel routes of administration. The regulatory considerations are crucial in translating these approaches into clinical practices. Conclusion The present review provides a comprehensive understanding of the molecular mechanisms, coupled with well-designed clinical trials and adherence to regulatory guidelines, which pave the way for nutrition-based combination therapies to become a frontline approach in early-stage BC treatment. Graphical Abstract

Background: Gynaecological oncology (GO) surgery involves a wide range of procedures, from minor diagnostic interventions to highly complex cytoreductive operations. Accurate perioperative diagnostics—particularly in major surgery—are critical to optimise patient care, predict morbidity, and facilitate shared decision-making. This study aimed to evaluate current practices in perioperative risk assessment amongst UK GO specialists, focusing on the use, perception, and applicability of diagnostic risk prediction tools. Methods: A national multicentre survey was distributed via the British Gynaecological Cancer Society (BGCS) to consultants, trainees, and nurse specialists. The questionnaire examined clinician familiarity with and use of existing tools such as POSSUM, P-POSSUM, and ACS NSQIP, as well as perceived reliability and areas for improvement. Results: Fifty-four clinicians responded, two-thirds of whom were consultant gynaecological oncologists. While 51.9% used morbidity prediction tools selectively, only 7.4% used them routinely for all major surgeries. The most common models were P-POSSUM (39.6%) and ACS NSQIP (25%), though over 20% did not use any formal tool. Despite this, 80% of respondents expressed a desire for more accurate, GO-specific models. Conclusions: This study reveals a gap between available perioperative diagnostics and real-world clinical use in GO surgical planning. There is an urgent need for validated, user-friendly, and GO-specific risk prediction tools—particularly for high-risk, complex surgical cases. Further research should focus on prospective validation of tools such as ACS NSQIP and their integration into routine practice to improve outcomes in gynaecological oncology.

[This corrects the article DOI: 10.1371/journal.pone.0221277.].

IntroductionNeoadjuvant therapy prior to oesophagogastric resection is the gold standard of care for patients with T2 and/or nodal disease. Despite this, studies have taught us that chemotherapy decreases patients’ functional capacity as assessed by cardiopulmonary exercise (CPX) testing. We aim to show that a multimodal prehabilitation programme, comprising supervised exercise, psychological coaching and nutritional support, will physically, psychologically and metabolically optimise these patients prior to oesophagogastric cancer surgery so they may better withstand the immense physical and metabolic stress placed on them by radical curative major surgery.Methods and analysisThis will be a prospective, randomised, controlled, parallel, single-centre superiority trial comparing a multimodal ‘prehabilitation’ intervention with ‘standard care’ in patients with oesophagogastric malignancy who are treated with neoadjuvant therapy prior to surgical resection. The primary aim is to demonstrate an improvement in baseline cardiopulmonary function as assessed by anaerobic threshold during CPX testing in an interventional (prehab) group following a 15-week preoperative exercise programme, throughout and following neoadjuvant treatment, when compared with those that undergo standard care (control group). Secondary objectives include changes in peak oxygen uptake and work rate (total watts achieved) at CPX testing, insulin resistance, quality of life, chemotherapy-related toxicity and completion, nutritional assessment, postoperative complication rate, length of stay and overall mortality.Ethics and disseminationThis study has been approved by the London-Bromley Research Ethics Committee and registered on ClinicalTrials.gov. The results will be disseminated in a peer-reviewed journal.Trial registration number NCT02950324; Pre-results.

Introduction/BackgroundAccurate postoperative surgical risk assessment is essential for surgeons and patient for assessment of potential post-operative complications especially with increasing numbers of patients with multiple comorbidities and frailty. Currently the most widely used risk scoring tool for post- operative risk prediction in the UK is P-POSSUM. Published data suggests that P-POSSUM overestimates risk causing undue patient anxiety.We continue to explore the accuracy of the ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) surgical risk calculator which is a validated web-based tool based on 21 preoperative risk factors to predict 8 post-operative outcomes and compare it with P-POSSUM.MethodologyR&D approved retrospective study on 1200 patients undergoing robotic, laparoscopic and open surgery between 2009–2020. Data collection done through a dedicated gynaeoncology database at a tertiary referral cancer centre by both anaesthetic and gynaeoncology team. Data collated on 540 patients undergoing robotic, 71 laparoscopic and 350 open surgery for suspected or confirmed gynaecological malignancy. Missing data collected from patient notes. Following data lock with actual post-op event that occurred in this retrospective cohort, the risk calculators were used to calculate predictive scores. Mortality and morbidity predictions using the Portsmouth modification of the POSSUM and ACS algorithm were compared to the actual outcomes separately.Baseline analysis of 153 patients undergoing robotic surgery was undertaken to explore possible co-relation between both two tools and to understand if they could be used to enhance patient understanding of risk in a subsequent prospective study. Data analysis evaluating P-POSSUM and ACS-NSQIP to assess its validity and relevance in gynaecological oncology patients undergoing robotic surgery performed.ResultsP-POSSUM reports on mortality and morbidity only; ACS-NSQIP reports individual complications as well. ACS-NSQIP risk prediction was most accurate for VTE(AUC-0.793), pneumonia(AUC-0657) and it showed 90% accuracy in prediction of 5 major complications (Brier score 0.01). Morbidity was much better predicted by ACS- NSQIP than by P-POSSUM (AUC-0.608 vs AUC-0.551) with same result in mortality (Brier score 0.0000). Moreover a statistically significant overestimation of morbidity has been shown by P-POSSUM calculator (p=0.018).ConclusionThe ACS-NSQIP risk calculator appears to be better predictor of major complications and mortality and it may be used by surgeons as an informed consent tool. Preliminary data suggests further validation needs to be performed to evaluate if the risk scores may be used to inform patients pre-operatively of their risk of complications and is currently being rolled out in a multi-centre model.DisclosuresThere are no disclosures to be made.

Introduction/BackgroundCohort of patients with multiple comorbidities, obesity and frailty requiring gynaeoncological interventions is continuously increasing and because of that there is an unmet need for an accurate perioperative risk prediction. The Duke Activity Scale Index (DASI) is a 12 item self-reported questionnaire based around commonly performed activities. DASI score determines functional capacity through conversion to Metabolic Equivalent of task (METs), which have been shown to indicate fitness for surgery. In our study we continue to investigate the accuracy of DASI in prediction of postoperative outcomes in the context of gynaeoncology.MethodologyA retrospective data for 290 patients was collected using a dedicated gynaeoncology database or patients’ notes at a tertiary oncology centre. All of the patients had filled the DASI questionnaire prior to surgery, which we used for the analysis. Actual postoperative complications which occurred within 30 days of the surgery were also recorded. The DASI score was then compared with the occurrence of postoperative complications.ResultsAccording to our preliminary analysis of 141 patients DASI score has not found to be a statistically significant model for prediction of postoperative complications in the general population of the gynaeoncology patients (AUC-0.433). However we were able to show that a 25 point higher DASI score is predicted to deliver 1 day less in hospital. We also found that DASI score could be promising for patients with ovarian and cervical malignancy (AUC-0.634 and AUC 0.750 respectively), but there were not enough patients to validate the findings in the analysed cohort (figures 1 and 2).Abstract 622 Figure 1Abstract 622 Figure 2ConclusionDASI is an uncomplicated and straightforward tool that could be useful in perioperative estimation of postoperative complications for ovarian and cervical cancer patients. Further analysis with a larger sample size and multicentre prospective study are currently underway to validate the findings.DisclosuresThere are no disclosures to be made.

Purpose: In this retrospective pilot study, we aim to evaluate the accuracy and reliability of the P-POSSUM and ACS-NSQIP surgical risk calculators in predicting postoperative complications in gynaecological–oncological (GO) robotic surgery (RS). Methods: Retrospective data collection undertaken through a dedicated GO database and patient notes at a tertiary referral cancer centre. Following data lock with the actual post-op event/complication, the risk calculators were used to measure predictive scores for each patient. Baseline analysis of 153 patients, based on statistician advice, was undertaken to evaluate P-POSSUM and ACS-NSQIP validity and relevance in GO patients undergoing RS performed. Results: P-POSSUM reports on mortality and morbidity only; ACS-NSQIP reports some individual complications as well. ACS-NSQIP risk prediction was most accurate for venous thromboembolism (VTE) (area under the curve (AUC)-0.793) and pneumonia (AUC-0.657) and it showed 90% accuracy in prediction of five major complications (Brier score 0.01). Morbidity was much better predicted by ACS-NSQIP than by P-POSSUM (AUC-0.608 vs. AUC-0.551) with the same result in mortality prediction (Brier score 0.0000). Moreover, a statistically significant overestimation of morbidity has been shown by the P-POSSUM calculator (p = 0.018). Conclusions: Despite the limitations of this pilot study, the ACS-NSQIP risk calculator appears to be a better predictor of major complications and mortality, making it suitable for use by GO surgeons as an informed consent tool. Larger data collection and analyses are ongoing to validate this further.

Impaired cardiac vagal function, quantified preoperatively as slower heart rate recovery (HRR) after exercise, is independently associated with perioperative myocardial injury. Parasympathetic (vagal) dysfunction may also promote (extra-cardiac) multi-organ dysfunction, although perioperative data are lacking. Assuming that cardiac vagal activity, and therefore heart rate recovery response, is a marker of brainstem parasympathetic dysfunction, we hypothesized that impaired HRR would be associated with a higher incidence of morbidity after noncardiac surgery. In two prospective, blinded, observational cohort studies, we established the definition of impaired vagal function in terms of the HRR threshold that is associated with perioperative myocardial injury (HRR [less than or equal to] 12 beats min.sup.-1 (bpm), 60 seconds after cessation of cardiopulmonary exercise testing. The primary outcome of this secondary analysis was all-cause morbidity three and five days after surgery, defined using the Post-Operative Morbidity Survey. Secondary outcomes of this analysis were type of morbidity and time to become morbidity-free. Logistic regression and Cox regression tested for the association between HRR and morbidity. Results are presented as odds/hazard ratios [OR or HR; (95% confidence intervals). 882/1941 (45.4%) patients had HRR[less than or equal to]12bpm. All-cause morbidity within 5 days of surgery was more common in 585/822 (71.2%) patients with HRR[less than or equal to]12bpm, compared to 718/1119 (64.2%) patients with HRR>12bpm (OR:1.38 (1.14-1.67); p = 0.001). HRR[less than or equal to]12bpm was associated with more frequent episodes of pulmonary (OR:1.31 (1.05-1.62);p = 0.02)), infective (OR:1.38 (1.10-1.72); p = 0.006), renal (OR:1.91 (1.30-2.79); p = 0.02)), cardiovascular (OR:1.39 (1.15-1.69); p<0.001)), neurological (OR:1.73 (1.11-2.70); p = 0.02)) and pain morbidity (OR:1.38 (1.14-1.68); p = 0.001) within 5 days of surgery. Multi-organ dysfunction is more common in surgical patients with cardiac vagal dysfunction, defined as HRR [less than or equal to] 12 bpm after preoperative cardiopulmonary exercise testing.

Impaired cardiac vagal function, quantified preoperatively as slower heart rate recovery (HRR) after exercise, is independently associated with perioperative myocardial injury. Parasympathetic (vagal) dysfunction may also promote (extra-cardiac) multi-organ dysfunction, although perioperative data are lacking. Assuming that cardiac vagal activity, and therefore heart rate recovery response, is a marker of brainstem parasympathetic dysfunction, we hypothesized that impaired HRR would be associated with a higher incidence of morbidity after noncardiac surgery. In two prospective, blinded, observational cohort studies, we established the definition of impaired vagal function in terms of the HRR threshold that is associated with perioperative myocardial injury (HRR [less than or equal to] 12 beats min.sup.-1 (bpm), 60 seconds after cessation of cardiopulmonary exercise testing. The primary outcome of this secondary analysis was all-cause morbidity three and five days after surgery, defined using the Post-Operative Morbidity Survey. Secondary outcomes of this analysis were type of morbidity and time to become morbidity-free. Logistic regression and Cox regression tested for the association between HRR and morbidity. Results are presented as odds/hazard ratios [OR or HR; (95% confidence intervals). 882/1941 (45.4%) patients had HRR[less than or equal to]12bpm. All-cause morbidity within 5 days of surgery was more common in 585/822 (71.2%) patients with HRR[less than or equal to]12bpm, compared to 718/1119 (64.2%) patients with HRR>12bpm (OR:1.38 (1.14-1.67); p = 0.001). HRR[less than or equal to]12bpm was associated with more frequent episodes of pulmonary (OR:1.31 (1.05-1.62);p = 0.02)), infective (OR:1.38 (1.10-1.72); p = 0.006), renal (OR:1.91 (1.30-2.79); p = 0.02)), cardiovascular (OR:1.39 (1.15-1.69); p<0.001)), neurological (OR:1.73 (1.11-2.70); p = 0.02)) and pain morbidity (OR:1.38 (1.14-1.68); p = 0.001) within 5 days of surgery. Multi-organ dysfunction is more common in surgical patients with cardiac vagal dysfunction, defined as HRR [less than or equal to] 12 bpm after preoperative cardiopulmonary exercise testing.