Analysis of spinal motion range, thoracic mobility, and abdominal muscle strength in patients operated on for renal cell carcinoma – a pilot, observational cross-sectional study at 3 to 5 years after the surgery

Analysis of spinal motion range, thoracic mobility, and abdominal muscle strength in patients operated on for renal cell carcinoma – a pilot, observational cross-sectional study at 3 to 5 years after the surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of spinal motion range, thoracic mobility, and abdominal muscle strength in patients operated on for renal cell carcinoma – a pilot, observational cross-sectional study at 3 to 5 years after the surgery Iwona Głowacka-Mrotek, Michał Jankowski, Magdalena Tarkowska, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5404653/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose With the prolongation of overall survival in patients with renal cell carcinoma, evaluation of the impact of the type of surgical procedure on patients’performance status is gaining particular importance. The purpose of this study was to analyze the balance and spinal motion range in patients having undergone total or partial renal resection. Methods This cross-sectional study was carried out ina group of patients having received surgical treatment for renal cell carcinoma at the Department of Urology of the Dr. Jan Biziel University Hospital No. 2 in Bydgoszcz 3 to 5 years prior to the inclusion. A total of 31 patients had undergone nephron-sparing surgery [NSS] while another 33 patients had undergone radical nephrectomy [RN]. The control group [CG] consisted of 24 age-range-matched patients. The purpose of the study was to evaluate the range of motion in the spinal joints, thoracic mobility, and abdominal muscle strength. Results Statistical analysis revealed highly significant differences between the study groups as regards the following parameters: total spine flexion (p = 0.0001), thoracic spine flexion (p < 0.0001), lumbar spine flexion (p < 0.0001), thoracic mobility (inhalation vs. exhalation) (p < 0.0001), rectus and oblique abdominal muscle strength (p < 0.0001). In all the aforementioned parameters, higher scores corresponded to better mobility. Higher scores and better range of motion in spinal joints were observed in the control group. No statistically significant differences between the groups (NSS, RN and CG) were observed in lumbar spine extension (backward inclination) (p > 0.05). Conclusions Surgical treatment within the kidneys is associated with reduction in the range of spinal motion, thoracic mobility, and abdominal muscle strength regardless of the type of surgery performed (nephron-sparing surgery vs. radical nephrectomy). renal cell carcinoma spinalmotion sparing treatment radical treatment Figures Figure 1 Introduction Renal cell carcinoma (RCC) accounts for 2.2% of all malignancies worldwide [1a]. Its prevalence is about twice as high in men as in women. The incidence of RCC reaches its peak in the 6th decade of life [ 1 ]. In Poland, about 2,500 new cases of this cancer are reported each year [ 1 ]. The first line of radical treatment consists in surgery involving complete (radical nephrectomy, RN) or partial removal of the kidney (nephron-sparing surgery, NSS) [ 2 ]. The development of minimally invasive surgical techniques has resulted in these surgeries being increasingly performed using laparoscopic approach, which is associated with shorter recovery times [ 2 ]. Data show that the state-of-the-art minimally invasive methods for the treatment of renal cell carcinoma, namely the robotic-assisted and laparoscopic surgical methods, have the efficacy that is comparable to standard open surgery [ 3 ]. During renal resection, the skin, subcutaneous tissue, rectus abdominis, and oblique abdominal muscles are incised sequentially. The scar resulting from the transection of these structures may limit the range of spinal motion as well as be the cause of pain[ 4 ]. Muscle strength and spinal joint mobility are important factors affecting the patients’ quality of life and daily functioning [ 5 ]; however, they have been rarely addressed in the literature on patients with renal cell carcinoma. Previous studies have confirmed the presence of abnormalities in postural parameters and spinal motion range in patients operated on for colon cancer [ 6 ]. 2. Objective of the study The objective of this study was to evaluate the effect of partial or total surgical resection of the kidney on spinal motion range, thoracic mobility, and abdominal muscle strength. Material and methods 3.1. Study design This observational cross-sectional study was approved by the Bioethics Committee of the Nicolaus Copernicus University in Toruń(decision no.283/2019).Informed consent was obtained from each participant. The inclusion of patients into the study began on 1.06.2022, and was completed on 31.08.2023. 3.2. Study enrollment The study population was selected from 259 adult patients operated on at the Department of Urology, Dr. Jan Biziel University Hospital No. 2 in Bydgoszcz between 2016 and 2018. Included in this number were 108 unilateral radical nephrectomies (RN), and 151 unilateral nephron-sparing surgeries (NSS). Following the qualification and written informed consent procedures, a total of 64 patients were deemed eligible to participate in the study, including 33 patients after unilateral RN, and 31 patients after NSS. All of these patients were subjected to measurements of spinal motion range and the assessments of abdominal muscle strength and balance at 3–5 years after the surgery. Study enrollment process is presented in Fig. 1 . (place for Fig. 1 ) Figure 1 . The diagram of the patient inclusion procedure. The control group consisted of 35 students of the University of the Third Age at the University of Economy in Bydgoszcz. The inclusion and exclusion criteria are presented in Table 1 Study group Control group Exclusion criteria Inclusion criteria Exclusion criteria Inclusion criteria active cancer ECOG 0–1 active cancer ECOG 0–1 uncompensated mental disorders Nephrectomy or nephron-sparing surgery (NSS) 3–5 years prior mental disorders no history of surgeries other serious ASA IVconditions severe neurological conditions Table. Eligibility criteria for the study group (SG) and the control group (CG) Within the study group, diagnostic examinations had been performed prior to the surgery to assess the progression of the disease and evaluate the patients’ condition. Other clinical data taken into consideration in the statistical analysis included the length of hospitalization after surgery, the presence of complications after surgery, and the type of surgical technique (open vs. laparoscopic). The surgical procedureshad been performed from two surgical approaches: open transperitoneal vs. laparoscopic. For radical nephrectomy procedures performed from the open access, a Bergmann-Israel incision was used, with the skin incision line running in parallel 1–2 fingers below the rib arch from the anterior axillary line to the midline between the xiphoid process and the umbilicus. The layers of the anterior abdominal wall were transected in a sequential manner: skin, subcutaneous tissue, external oblique, internal oblique, and transverse abdominal muscles to reach the rectus abdominis muscle. Next, the peritoneum was transected, the length of the incision being about 25–30 cm. In order to maintain the view of the surgical field, the edges of the abdominal integuments were pulled away and stabilized by a retractor. Laparoscopic procedures (RN, NSS) started from peritoneal emphysema being established using a Veres needle and were continued with 3 or 4 trocars: 2 × 5 mm and 2 × 10 mm. The number and type of instruments used depended on the operator's preference. For laparoscopic procedures, the kidney was removed through a minilaparotomy, i.e. a 5–10 cm parasternal abdominal incision; in the case of NSS procedures, the resected tumor was secured in an extraction pouch and removed through the opening of an optical trocar (12 mm). Notably, the extent of dissection of perirenal fat tissue potentially affecting the mobility of the resected lesion during NSS procedures was variable depending on the location of the tumor. The decision regarding the type of surgery (radical vs. nephron-sparing) was based on AUA guidelines as well as the surgeon’s and the patient’s decision. The following schedule was followed in the course of physiotherapeutic examination of all patients: 1. The patient's weight and height were measured, with BMI being calculated on the basis of measurement results. 2. Next, a measuring tape was used to take the following measurements: Thoracic spine flexion, the initial measurement covering the distance between Th1(the spinous process of the first thoracic vertebra) and Th12 (the spinous process of the 12th thoracic vertebra), the final measurement covering the distance from Th1 to Th12 after the patient had made a full forward bend. The range of motion of the thoracic spine was defined as the difference between the final measurement and the initial measurement. Lumbarspine flexion, the initial measurement covering the distance between L1 (the spinous process of the first lumbar vertebra) and L5 (the spinous process of the 5th lumbarvertebra), the final measurement covering the distance from L1 to L5 after the patient had made a full forward bend. The range of motion of the lumbarspine was defined as the difference between the final measurement and the initial measurement. Total spine flexion (forward inclination). The distance between the external occipital protuberanceto the medial crest of the sacrum was measured. Next, the same distance was measured when the patient had made a full forward bend. The total range of spinal motion was defined as the difference between the final measurement and the initial measurement. Lumbar spine extension. The distance between the tip of the xiphoid process and the pubic bone was measured, followed by the distance between the same points being measured after a backward inclination had been performed by the patient. The range of lumbar extension was defined as the difference between the final measurement and the initial measurement. Lateral flexion of the thoracolumbar spine. The distance between the armpit and the hip plate was measured in the patient in a relaxed standing position. Next, the patient was asked to do a sideward bend and the same distance was measured again. The range of motion was defined as the difference between the final measurement and the initial measurement. The measurements were taken bilaterally. Thoracolumbar spine twist. The distance from the tip of the xiphoid process to the superior anterior iliac spine was measured, followed by the same measurement being made after the patient had performed a twist of the trunk in the opposite direction. The range of motion was defined as the difference between the final measurement and the initial measurement. The measurementsweretakenbilaterally. 3. The chest circumference was measured upon inspiration and expiration. The calculated difference in inhalation minus exhalation circumference was defined as thoracic mobility. 4. The assessment of the strength of the rectus abdominis muscles was carried out in supine position with lower limbs being flexed at knee and hip joints. The patient was instructed to perform a forward crunch with the tester being applied to the rectus abdominis muscle. 5. The abdominal muscle obliquestrength was assessed in supine position with lower limbs being flexed at knee and hip joints. The patient was instructed to perform a crunch towards the right and the left knees. During the crunch, the tester was applied to abdominal oblique muscles on the left and then on the right. The resultswererecorded. 6. The straight and oblique abdominal muscle strength was assessed using the MicroFET hand-held dynamometer 3.3 Statistical methods Statistical analyses were carried out using the PQStat ver. 1.8.4.152 statistical package. The qualitative variables, i.e. gender and operated side, were analyzed between all groups using the chi-squared correlation test and the post-hoc test with Bonferroni correction. The quantitative variables were analyzed between all groups (when k = 3) using the Kruskal-Wallis test and post-hoc Dunn's test with Bonferroni correction. In cases when two groups were being compared (k = 2), the Mann-Whitney U-test was used. Test probability of p < 0.05 was considered to be indicative of statistical significance and the test probability of p < 0.01 was considered to be indicative of high statistical significance. Results Included in the analysis was the data obtained from 64 patients (31 NSS, 33 RN) comprising the study group (SG) and 35 healthy control subjects (CG). The groups (NSS, RN and CG) were characterized in terms of demographic data. Groups did not differ in gender, age, body mass, or BMI (p > 0.05). The NSS and RN groups were also evaluated in terms of the side of the surgery and the length of hospitalization, with no statistically significant differences being observed in these aspects (p > 0.05). The results are shown in Table 2 . Table 2 Quantitative and qualitative clinical data in the studied groups of patients (NSS, NR, and CG) and relationships between groups. Variable NSS N = 32 RN N = 44 CG N = 35 Age 68 (51,75 − 73,25) 66 (59,75 − 72,25) 68 (63,5–58,5) H = 0,2592 p = 0,8785 Gender Women Men 15 (46,88%) 17 (53,13%) 17 (38,64%) 27 (61,36%) 19 (54,29%) 16 (45,71%) Chi^2 = 1,9379 p = 0,3795 Body mass 78,5 (73–87) 79,5 (71,25–94,25) 78 (67,75–83) H = 1,8080 p = 0,4049 Height 164 (160–176) 168 (165–174) 166 (160–173) H = 0,7923 p = 0,6729 BMI 29,31 (26,29–30,55) 27,92 (25,84 − 32,79) 26,64 (25,33 − 29,73) H = 2,5971 p = 0,2729 Operated side Left Right 18 (58,06%) 13 (41,94%) 19 (44,19%) 24 (55,81%) --- Chi^2 = 1,3878 P = 0,2388 Duration of hospital stage 7 (5–9) 6,5 (6–10) --- Z = 0,29 p = 0,7696 NSS – nephron-sparing surgery; RN – radical nephrectomy; CG – control group; p – statistical significance level; BMI – body mass index. The same letter next to two arithmetic indicates no significant difference (p > 0.05); if the same letter is missing from the two medians being compared, the medians (distributions) are significantly different (p < 0.05). Spinal joint motion range, thoracic mobility, and strength of the rectus and oblique abdominal muscles were assessed in the study groups (NSS, RN and CG). The results are summarized in Table 3 . Table 3 Spinal joint motion range, abdominal muscle strength assessment, and thoracic mobility assessments in the study groups (NSS, NR, and CG) and the resulting differences between thegroups as found in respective assessments. NSS (nephron- sparing surgery) NR (radical nephrectomy) Control Group Test Total spine flexion 5 (3–6,5) a 4 (3–5) a 7,5 (5–10) b H = 19,33 p = 0,0001 Thoracic spine flexion 3 (2–3,5) b 1 (1–1,5) b 3 (2–3) a H = 35,88 p < 0,0001 Lumbar spine flexion 2 (2–3) a 3 (2–3) a 7,75 (5–12) b H = 48,99 p < 0,0001 Lumbar spine extension 2 (1–2) 5 (1–3) 2 (1,5 − 3) H = 2,37 p = 0,3052 Lateral thoracolumbar spine flexion, Operated side 3 (2–4) 3 (2–4) --- Z = 0,13 p = 0,8979 Lateral thoracolumbar spine flexion, Healthy side 3 (2–4) 4 (2–5,5) --- Z = 1,54 p = 0,1238 Thoracolumbar spine rotation, Operated side 2 (1–3) 2 (1–3,5) --- Z = 1,56 p = 0,1193 Thoracolumbar spine rotation, ,, Healthy side’’ 2 (1–3) 2 (1–4) --- Z = 1,47 p = 0,1417 Inhalation-exhalation difference (chest mobili ty) 2,5 (2–4) a 2 (1,5 − 3,25) a 5,25 (4–7) b H = 28,46 p < 0,0001 Rectus abdominis muscles’ strength 20 (17–25) a 22 (17,85 − 31,3) a 38 (34,35–41,42) b H = 39,10 p < 0,0001 Abdominal oblique muscles’ strength, R 17 (14–19,75) a 19 (14–24) a 34,7 (28,85 − 39,32) b H = 45,10 p < 0,0001 Abdominal oblique muscles’ strength, L 18,5 (15,25 − 22,5) a 22 (17–28,2) a 37,35 (32,9–43,97) b H = 42,94 p 0.05); if the same letter is missing from the two medians being compared, the medians (distributions) are significantly different (p < 0.05). Statistical analysis revealed highly significant differences between the study groups as regards the following parameters: total spinal flexion (p = 0.0001), thoracic spine flexion (p < 0.0001), lumbar spine flexion (p < 0.0001), thoracic mobility (inhalation vs. exhalation) (p < 0.0001), rectus and oblique abdominal muscle strength (p < 0.0001). In all the aforementioned parameters, higher scores corresponded to better mobility. Higher scores and better range of motion in spinal joints were observed in the control group. No statistically significant differences between the groups (NSS, RN and CG) were observed in lumbar spine extension (backward inclination) (p > 0.05). Statistical analysis revealed no statistically significant differences between the NSS and NS groups with regard to any of the parameters studied. Discussion In this study, spinal motion range, thoracic mobility, and the abdominal rectus and oblique muscle strength were assessed in patients operated on for renal cell carcinoma by means of nephron-sparing surgery (NSS) or radical nephrectomy (RN). The results were compared to these obtained in the control group consisting of healthy subjects of similar age. The study groups (NSS, RN and CG) did not differ in terms of demographics, including age, BMI, or gender. In the study, patients within the study groups (NSS and NR) were found to present with statistically significantly worse results as compared to the control subjects with regard to the following parameters: total spine flexion, thoracic spine flexion, lumbar spine flexion, thoracic mobility, and the straight and oblique abdominal muscle strength. No differences in spinal motion range, abdominal muscle strength, and thoracic mobility were found between the NSS and RN groups. Both surgical procedures (RN and NSS) violate the continuity of skin, subcutaneous and muscular tissue as well as internal organs. In our study, patients operated on by both the sparing and radical methods presented with postoperative scars. In the case of radical nephrectomy, the cut on the surgical sidewas about 25–30 cm in length as compared to about 10 cm in the case of laparoscopic procedures. Postoperative scarring can result in the reduced range of motion and skin elasticity as well as in tenderness or itching on one side, combined with certain functional limitations such as contractures on the contralateral side [ 8 – 11 ]. In addition, the aesthetics of scars can also translate to psychosocial problems and limited activity of patients. Surgical scar care would be a welcome addition to the overall management regimen. Enhancing the flexibility of scars can have a positive effect on reducing pain, increasing the elasticity of skin, and improving sensations as perceived in the scar area. Limitation of mobility in patients having undergone surgical treatment of kidney cancer may be influenced by lack of physical activity. Studies show that patients treated for cancer limit their physical activity [ 12 ]. As shown by recent reports, regular physical activity should be an integral part of the management of cancer patients. Studies show that regular physical activity can reduce cancer recurrence and improve the quality of life of patients receiving cancer treatment [ 13 , 14 ]. It should be noted that the patients included in this retrospective study had not undergone prehabilitation and postoperative rehabilitation. Scientific reports show that prehabilitation should be a standard constituent of the management of patients preparing for surgery. Patients who have undergone the prehabilitation process are quicker to return to physical fitness after surgery [ 15 ]. Studies show that prehabilitation programs lasting as briefly as 4 weeks are capable of bringing benefitsto cancer patients in terms of reduced hospitalization times and faster postoperative recovery [ 16 ]. In our study, no statistically significant differences were observed in spinal motion range, thoracic mobility, and abdominal strength in patients treated for renal cell carcinoma by means of nephron-sparing surgery vs. radical nephrectomy. No papers by other authors comparing these parameters depending on the extent of the surgery are available in the literature. Less invasive methods are associated with smaller incisions, less pain, and shorter recovery after surgery [ 17 , 18 ]. Other authors also point to the lower severity of somatic symptoms such as fatigue or insomnia, as well as to better physical functioning in patients treated with NSS up to 4 years after surgery [ 19 ]. 6. Study limitation Our study has certain limitations. One of these consists in the small size of the study sample as well as the lack of randomization. Due to the retrospective nature of the study, it was not possible to assess the baseline levels prior to surgery. Another limitation potentially affecting the results consisted in the composition of the control group, where the majority of subjects were female, with a highly significant difference in gender distribution being noted between the study groups as the result. However, a significant difference in the spinal motion parameters was also observed. The single-center nature of the study should also be listed among the limitations, although, on the other hand, it translated to natural standardization of the results of surgical treatment. Conclusion As shown by the results of our study, patients operated on for kidney cancer present with a reduction in the range of spinal motion, thoracic mobility, and abdominal muscle strength as compared to the control group regardless of the type of surgery performed (nephron-sparing surgery vs. radical nephrectomy). Declarations Acknowledgments None. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate The research was approved by the Bioethics Committee of the Medical University in Wroclaw. Before participating in the research, each participant signed a consent to participate in the project Author Contributions: Conception and design: I.G.-M., M.J., M.T., P.J Collection and assembly of data: I.G.-M., T.N., D.R.-S., A.L. Data analysis and interpretation: M.T., I.G.-M.,.Administrative support: I.G.-M., M.M.-M., B.B., Ł.L., P.P Manuscript writing: I.G.-M. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate: The study was conducted under the ethical standards of the Declaration of Helsinki and approved by the Bioethics Committee at the Nicolaus Copernicus University in Torun (decision no.283/2019). Before participating in the research, each participant signed a consent to participate in the project. Consent for publication Not applicable. Competing interests All authors declare that they have no competing interests. References Wojcieszak PZ, Poletajew S, Rutkowski D, Radziszewski, P (2014) The incidence of renal cancer in Polish National Cancer Registry: is there any epidemiological data we can rely on? Cent. European J Urol 67,(3):253-6. Ferro M, Musi G, Marchioni M, Maggi M, Veccia A, Del Giudice F, Barone B Crocetto F, Lasorsa, F, Antonelli, A et al. (2023) Radiogenomics in Renal Cancer Management—Current Evidence and Future Prospects. Int J Mol Sci 24 , 4615. Novara G, Secco S, Botteri, M et al (2010) Factors predicting health-related quality of life recovery in patients undergoing surgical treatment for renal tumors: prospective evaluation using the RAND SF-36 Health Survey Eur Urol 57(1):112–120. 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(2007) Comparison of 1,800 laparoscopic and open partialnephrectomies for single renal tumors. J. Urol 178(1):41–46. Hollenbeck B K, Taub D A, Miller D C, Dunn R L, Wei J T (2006) National utilization trends of partial nephrectomy for renal cell carcinoma: a case of underutilization? Urology 67(2):254–259. Azawi NH, Tesfalem H, Dahl C, Lund L (2015) Do the different types of renal surgery impact the quality of life in the postoperative period? Int Urol Nephrol. 47(2):263-9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Medicum in Bydgoszcz","correspondingAuthor":false,"prefix":"","firstName":"Łukasz","middleName":"","lastName":"Leksowski","suffix":""},{"id":391426758,"identity":"50a9121a-0c84-49aa-bca1-6e31b20d347c","order_by":5,"name":"Anna Lewandowska","email":"","orcid":"","institution":"Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Lewandowska","suffix":""},{"id":391426760,"identity":"43ed256f-784d-47fd-9f65-e8fada2e449d","order_by":6,"name":"Piotr Porzych","email":"","orcid":"","institution":"Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz","correspondingAuthor":false,"prefix":"","firstName":"Piotr","middleName":"","lastName":"Porzych","suffix":""},{"id":391426762,"identity":"caa2c2bc-f801-4150-955e-1216e93d2244","order_by":7,"name":"Piotr Jarzemski","email":"","orcid":"","institution":"Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz","correspondingAuthor":false,"prefix":"","firstName":"Piotr","middleName":"","lastName":"Jarzemski","suffix":""},{"id":391426763,"identity":"1435d92e-d1ac-455d-8a58-b532703643e9","order_by":8,"name":"Tomasz Nowikiewicz","email":"","orcid":"","institution":"Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz","correspondingAuthor":false,"prefix":"","firstName":"Tomasz","middleName":"","lastName":"Nowikiewicz","suffix":""},{"id":391426764,"identity":"d52d6caa-074a-4d89-9a9b-9f3d829cb29b","order_by":9,"name":"Magdalena Mackiewicz-Milewska","email":"","orcid":"","institution":"Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz","correspondingAuthor":false,"prefix":"","firstName":"Magdalena","middleName":"","lastName":"Mackiewicz-Milewska","suffix":""}],"badges":[],"createdAt":"2024-11-06 17:23:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5404653/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5404653/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72283473,"identity":"71c390ae-3c5c-445b-abd3-e6a27538ad4f","added_by":"auto","created_at":"2024-12-24 16:40:52","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":116566,"visible":true,"origin":"","legend":"\u003cp\u003eThe diagram of the patient inclusion procedure.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5404653/v1/5d07cddc36fa95679993f700.png"},{"id":73905401,"identity":"00abd2a0-e94d-4011-97c0-3ba8415ea838","added_by":"auto","created_at":"2025-01-15 19:16:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":800698,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5404653/v1/735e8e59-5eb3-45ce-a2e4-7d6afb80d220.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of spinal motion range, thoracic mobility, and abdominal muscle strength in patients operated on for renal cell carcinoma – a pilot, observational cross-sectional study at 3 to 5 years after the surgery","fulltext":[{"header":"Introduction","content":"\u003cp\u003eRenal cell carcinoma (RCC) accounts for 2.2% of all malignancies worldwide [1a]. Its prevalence is about twice as high in men as in women. The incidence of RCC reaches its peak in the 6th decade of life [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Poland, about 2,500 new cases of this cancer are reported each year [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The first line of radical treatment consists in surgery involving complete (radical nephrectomy, RN) or partial removal of the kidney (nephron-sparing surgery, NSS) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The development of minimally invasive surgical techniques has resulted in these surgeries being increasingly performed using laparoscopic approach, which is associated with shorter recovery times [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Data show that the state-of-the-art minimally invasive methods for the treatment of renal cell carcinoma, namely the robotic-assisted and laparoscopic surgical methods, have the efficacy that is comparable to standard open surgery [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. During renal resection, the skin, subcutaneous tissue, rectus abdominis, and oblique abdominal muscles are incised sequentially. The scar resulting from the transection of these structures may limit the range of spinal motion as well as be the cause of pain[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Muscle strength and spinal joint mobility are important factors affecting the patients\u0026rsquo; quality of life and daily functioning [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]; however, they have been rarely addressed in the literature on patients with renal cell carcinoma. Previous studies have confirmed the presence of abnormalities in postural parameters and spinal motion range in patients operated on for colon cancer [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003e2. Objective of the study\u003c/h3\u003e\n\u003cp\u003eThe objective of this study was to evaluate the effect of partial or total surgical resection of the kidney on spinal motion range, thoracic mobility, and abdominal muscle strength.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e3.1. Study design\u003c/h2\u003e\n \u003cp\u003eThis observational cross-sectional study was approved by the Bioethics Committee of the Nicolaus Copernicus University in Toruń(decision no.283/2019).Informed consent was obtained from each participant. The inclusion of patients into the study began on 1.06.2022, and was completed on 31.08.2023.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e3.2. Study enrollment\u003c/h2\u003e\n \u003cp\u003eThe study population was selected from 259 adult patients operated on at the Department of Urology, Dr. Jan Biziel University Hospital No. 2 in Bydgoszcz between 2016 and 2018. Included in this number were 108 unilateral radical nephrectomies (RN), and 151 unilateral nephron-sparing surgeries (NSS). Following the qualification and written informed consent procedures, a total of 64 patients were deemed eligible to participate in the study, including 33 patients after unilateral RN, and 31 patients after NSS. All of these patients were subjected to measurements of spinal motion range and the assessments of abdominal muscle strength and balance at 3\u0026ndash;5 years after the surgery. Study enrollment process is presented in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e(place for Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\n \u003cp\u003eFigure \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. The diagram of the patient inclusion procedure.\u003c/p\u003e\n \u003cp\u003eThe control group consisted of 35 students of the University of the Third Age at the University of Economy in Bydgoszcz. The inclusion and exclusion criteria are presented in \u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eStudy group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExclusion criteria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInclusion criteria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eExclusion criteria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eInclusion criteria\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eactive cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eECOG 0\u0026ndash;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eactive cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eECOG 0\u0026ndash;1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003euncompensated mental disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNephrectomy or nephron-sparing surgery (NSS) 3\u0026ndash;5 years prior\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003emental disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eno history of surgeries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eother serious ASA IVconditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003esevere neurological conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003eTable. Eligibility criteria for the study group (SG) and the control group (CG)\u003c/p\u003e\n \u003cp\u003eWithin the study group, diagnostic examinations had been performed prior to the surgery to assess the progression of the disease and evaluate the patients\u0026rsquo; condition. Other clinical data taken into consideration in the statistical analysis included the length of hospitalization after surgery, the presence of complications after surgery, and the type of surgical technique (open vs. laparoscopic).\u003c/p\u003e\n \u003cp\u003eThe surgical procedureshad been performed from two surgical approaches: open transperitoneal vs. laparoscopic. For radical nephrectomy procedures performed from the open access, a Bergmann-Israel incision was used, with the skin incision line running in parallel 1\u0026ndash;2 fingers below the rib arch from the anterior axillary line to the midline between the xiphoid process and the umbilicus. The layers of the anterior abdominal wall were transected in a sequential manner: skin, subcutaneous tissue, external oblique, internal oblique, and transverse abdominal muscles to reach the rectus abdominis muscle. Next, the peritoneum was transected, the length of the incision being about 25\u0026ndash;30 cm. In order to maintain the view of the surgical field, the edges of the abdominal integuments were pulled away and stabilized by a retractor.\u003c/p\u003e\n \u003cp\u003eLaparoscopic procedures (RN, NSS) started from peritoneal emphysema being established using a Veres needle and were continued with 3 or 4 trocars: 2 \u0026times; 5 mm and 2 \u0026times; 10 mm. The number and type of instruments used depended on the operator\u0026apos;s preference. For laparoscopic procedures, the kidney was removed through a minilaparotomy, i.e. a 5\u0026ndash;10 cm parasternal abdominal incision; in the case of NSS procedures, the resected tumor was secured in an extraction pouch and removed through the opening of an optical trocar (12 mm). Notably, the extent of dissection of perirenal fat tissue potentially affecting the mobility of the resected lesion during NSS procedures was variable depending on the location of the tumor. The decision regarding the type of surgery (radical vs. nephron-sparing) was based on AUA guidelines as well as the surgeon\u0026rsquo;s and the patient\u0026rsquo;s decision.\u003c/p\u003e\n \u003cp\u003eThe following schedule was followed in the course of physiotherapeutic examination of all patients:\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e1. The patient\u0026apos;s weight and height were measured, with BMI being calculated on the basis of measurement results.\u003c/p\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003e2. Next, a measuring tape was used to take the following measurements:\u003c/h3\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eThoracic spine flexion, the initial measurement covering the distance between Th1(the spinous process of the first thoracic vertebra) and Th12 (the spinous process of the 12th thoracic vertebra), the final measurement covering the distance from Th1 to Th12 after the patient had made a full forward bend. The range of motion of the thoracic spine was defined as the difference between the final measurement and the initial measurement.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eLumbarspine flexion, the initial measurement covering the distance between L1 (the spinous process of the first lumbar vertebra) and L5 (the spinous process of the 5th lumbarvertebra), the final measurement covering the distance from L1 to L5 after the patient had made a full forward bend. The range of motion of the lumbarspine was defined as the difference between the final measurement and the initial measurement.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eTotal spine flexion (forward inclination). The distance between the external occipital protuberanceto the medial crest of the sacrum was measured. Next, the same distance was measured when the patient had made a full forward bend. The total range of spinal motion was defined as the difference between the final measurement and the initial measurement.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eLumbar spine extension. The distance between the tip of the xiphoid process and the pubic bone was measured, followed by the distance between the same points being measured after a backward inclination had been performed by the patient. The range of lumbar extension was defined as the difference between the final measurement and the initial measurement.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eLateral flexion of the thoracolumbar spine. The distance between the armpit and the hip plate was measured in the patient in a relaxed standing position. Next, the patient was asked to do a sideward bend and the same distance was measured again. The range of motion was defined as the difference between the final measurement and the initial measurement. The measurements were taken bilaterally.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eThoracolumbar spine twist. The distance from the tip of the xiphoid process to the superior anterior iliac spine was measured, followed by the same measurement being made after the patient had performed a twist of the trunk in the opposite direction. The range of motion was defined as the difference between the final measurement and the initial measurement. The measurementsweretakenbilaterally.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e3. \u0026nbsp; \u0026nbsp;The chest circumference was measured upon inspiration and expiration. The calculated difference in inhalation minus exhalation circumference was defined as thoracic mobility.\u003c/p\u003e\n\u003cp\u003e4. \u0026nbsp; \u0026nbsp;The assessment of the strength of the rectus abdominis muscles was carried out in supine position with lower limbs being flexed at knee and hip joints. The patient was instructed to perform a forward crunch with the tester being applied to the rectus abdominis muscle.\u003c/p\u003e\n\u003cp\u003e5.\u0026nbsp; \u0026nbsp;\u0026nbsp;The abdominal muscle obliquestrength was assessed in supine position with lower limbs being flexed at knee and hip joints. The patient was instructed to perform a crunch towards the right and the left knees. During the crunch, the tester was applied to abdominal oblique muscles on the left and then on the right. The resultswererecorded.\u003c/p\u003e\n\u003cp\u003e6. \u0026nbsp; \u0026nbsp;The straight and oblique abdominal muscle strength was assessed using the MicroFET hand-held dynamometer\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003ch2\u003e3.3 Statistical methods\u003c/h2\u003e\n\u003cp\u003eStatistical analyses were carried out using the PQStat ver. 1.8.4.152 statistical package.\u003c/p\u003e\n\u003cp\u003eThe qualitative variables, i.e. gender and operated side, were analyzed between all groups using the chi-squared correlation test and the post-hoc test with Bonferroni correction.\u003c/p\u003e\n\u003cp\u003eThe quantitative variables were analyzed between all groups (when k\u0026thinsp;=\u0026thinsp;3) using the Kruskal-Wallis test and post-hoc Dunn\u0026apos;s test with Bonferroni correction. In cases when two groups were being compared (k\u0026thinsp;=\u0026thinsp;2), the Mann-Whitney U-test was used.\u003c/p\u003e\n\u003cp\u003eTest probability of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to be indicative of statistical significance and the test probability of p\u0026thinsp;\u0026lt;\u0026thinsp;0.01 was considered to be indicative of high statistical significance.\u003c/p\u003e\n"},{"header":"Results","content":"\u003cp\u003eIncluded in the analysis was the data obtained from 64 patients (31 NSS, 33 RN) comprising the study group (SG) and 35 healthy control subjects (CG). The groups (NSS, RN and CG) were characterized in terms of demographic data. Groups did not differ in gender, age, body mass, or BMI (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The NSS and RN groups were also evaluated in terms of the side of the surgery and the length of hospitalization, with no statistically significant differences being observed in these aspects (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuantitative and qualitative clinical data in the studied groups of patients (NSS, NR, and CG) and relationships between groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNSS\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;32\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRN\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;44\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCG N\u0026thinsp;=\u0026thinsp;35\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003cp\u003e(51,75\u0026thinsp;\u0026minus;\u0026thinsp;73,25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003cp\u003e(59,75\u0026thinsp;\u0026minus;\u0026thinsp;72,25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68\u003c/p\u003e \u003cp\u003e(63,5\u0026ndash;58,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;0,2592\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,8785\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eWomen\u003c/p\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (46,88%)\u003c/p\u003e \u003cp\u003e17 (53,13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (38,64%)\u003c/p\u003e \u003cp\u003e27 (61,36%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19 (54,29%)\u003c/p\u003e \u003cp\u003e16 (45,71%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChi^2\u0026thinsp;=\u0026thinsp;1,9379\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,3795\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78,5\u003c/p\u003e \u003cp\u003e(73\u0026ndash;87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79,5\u003c/p\u003e \u003cp\u003e(71,25\u0026ndash;94,25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78\u003c/p\u003e \u003cp\u003e(67,75\u0026ndash;83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;1,8080\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,4049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e164\u003c/p\u003e \u003cp\u003e(160\u0026ndash;176)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e168\u003c/p\u003e \u003cp\u003e(165\u0026ndash;174)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e166\u003c/p\u003e \u003cp\u003e(160\u0026ndash;173)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;0,7923\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,6729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29,31\u003c/p\u003e \u003cp\u003e(26,29\u0026ndash;30,55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27,92\u003c/p\u003e \u003cp\u003e(25,84\u0026thinsp;\u0026minus;\u0026thinsp;32,79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26,64\u003c/p\u003e \u003cp\u003e(25,33\u0026thinsp;\u0026minus;\u0026thinsp;29,73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;2,5971\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,2729\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperated side\u003c/p\u003e \u003cp\u003eLeft\u003c/p\u003e \u003cp\u003eRight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (58,06%)\u003c/p\u003e \u003cp\u003e13 (41,94%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (44,19%)\u003c/p\u003e \u003cp\u003e24 (55,81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChi^2\u0026thinsp;=\u0026thinsp;1,3878\u003c/p\u003e \u003cp\u003eP\u0026thinsp;=\u0026thinsp;0,2388\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of hospital stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003cp\u003e(5\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6,5\u003c/p\u003e \u003cp\u003e(6\u0026ndash;10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;0,29\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,7696\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eNSS \u0026ndash; nephron-sparing surgery; RN \u0026ndash; radical nephrectomy; CG \u0026ndash; control group; p \u0026ndash; statistical significance level; BMI \u0026ndash; body mass index.\u003c/p\u003e \u003cp\u003eThe same letter next to two arithmetic indicates no significant difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05); if the same letter is missing from the two medians being compared, the medians (distributions) are significantly different (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eSpinal joint motion range, thoracic mobility, and strength of the rectus and oblique abdominal muscles were assessed in the study groups (NSS, RN and CG). The results are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpinal joint motion range, abdominal muscle strength assessment, and thoracic mobility assessments in the study groups (NSS, NR, and CG) and the resulting differences between thegroups as found in respective assessments.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNSS (nephron- sparing surgery)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNR (radical nephrectomy)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTest\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal spine flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e(3\u0026ndash;6,5)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e(3\u0026ndash;5)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,5\u003c/p\u003e \u003cp\u003e(5\u0026ndash;10)\u003c/p\u003e \u003cp\u003eb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;19,33\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThoracic spine flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(2\u0026ndash;3,5)\u003c/p\u003e \u003cp\u003eb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e(1\u0026ndash;1,5)\u003c/p\u003e \u003cp\u003eb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(2\u0026ndash;3)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;35,88\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLumbar spine flexion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(2\u0026ndash;3)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(2\u0026ndash;3)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7,75\u003c/p\u003e \u003cp\u003e(5\u0026ndash;12)\u003c/p\u003e \u003cp\u003eb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;48,99\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLumbar spine extension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(1\u0026ndash;2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e(1\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(1,5\u0026thinsp;\u0026minus;\u0026thinsp;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;2,37\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,3052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLateral thoracolumbar spine flexion, Operated side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;0,13\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,8979\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLateral thoracolumbar spine flexion, Healthy side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e(2\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e(2\u0026ndash;5,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1,54\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,1238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThoracolumbar spine rotation, Operated side\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(1\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(1\u0026ndash;3,5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1,56\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,1193\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThoracolumbar spine rotation, ,, Healthy side\u0026rsquo;\u0026rsquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(1\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e---\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;1,47\u003c/p\u003e \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,1417\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInhalation-exhalation difference\u003c/p\u003e \u003cp\u003e(chest mobili ty)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,5\u003c/p\u003e \u003cp\u003e(2\u0026ndash;4)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e(1,5\u0026thinsp;\u0026minus;\u0026thinsp;3,25)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5,25\u003c/p\u003e \u003cp\u003e(4\u0026ndash;7)\u003c/p\u003e \u003cp\u003eb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;28,46\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRectus abdominis muscles\u0026rsquo; strength\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003cp\u003e(17\u0026ndash;25)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003cp\u003e(17,85\u0026thinsp;\u0026minus;\u0026thinsp;31,3)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38\u003c/p\u003e \u003cp\u003e(34,35\u0026ndash;41,42)\u003c/p\u003e \u003cp\u003eb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;39,10\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal oblique muscles\u0026rsquo; strength, R\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003cp\u003e(14\u0026ndash;19,75)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e(14\u0026ndash;24)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34,7\u003c/p\u003e \u003cp\u003e(28,85\u0026thinsp;\u0026minus;\u0026thinsp;39,32)\u003c/p\u003e \u003cp\u003eb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;45,10\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbdominal oblique muscles\u0026rsquo; strength, L\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18,5\u003c/p\u003e \u003cp\u003e(15,25\u0026thinsp;\u0026minus;\u0026thinsp;22,5)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003cp\u003e(17\u0026ndash;28,2)\u003c/p\u003e \u003cp\u003ea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37,35\u003c/p\u003e \u003cp\u003e(32,9\u0026ndash;43,97)\u003c/p\u003e \u003cp\u003eb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eH\u0026thinsp;=\u0026thinsp;42,94\u003c/p\u003e \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eNSS \u0026ndash; nephron-sparing surgery; RN \u0026ndash; radical nephrectomy; CG \u0026ndash; control group; p \u0026ndash; statistical significance level.\u003c/p\u003e \u003cp\u003eThe same letter next to two arithmetic indicates no significant difference (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05); if the same letter is missing from the two medians being compared, the medians (distributions) are significantly different (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eStatistical analysis revealed highly significant differences between the study groups as regards the following parameters: total spinal flexion (p\u0026thinsp;=\u0026thinsp;0.0001), thoracic spine flexion (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), lumbar spine flexion (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), thoracic mobility (inhalation vs. exhalation) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), rectus and oblique abdominal muscle strength (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In all the aforementioned parameters, higher scores corresponded to better mobility. Higher scores and better range of motion in spinal joints were observed in the control group.\u003c/p\u003e \u003cp\u003eNo statistically significant differences between the groups (NSS, RN and CG) were observed in lumbar spine extension (backward inclination) (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eStatistical analysis revealed no statistically significant differences between the NSS and NS groups with regard to any of the parameters studied.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, spinal motion range, thoracic mobility, and the abdominal rectus and oblique muscle strength were assessed in patients operated on for renal cell carcinoma by means of nephron-sparing surgery (NSS) or radical nephrectomy (RN). The results were compared to these obtained in the control group consisting of healthy subjects of similar age. The study groups (NSS, RN and CG) did not differ in terms of demographics, including age, BMI, or gender. In the study, patients within the study groups (NSS and NR) were found to present with statistically significantly worse results as compared to the control subjects with regard to the following parameters: total spine flexion, thoracic spine flexion, lumbar spine flexion, thoracic mobility, and the straight and oblique abdominal muscle strength. No differences in spinal motion range, abdominal muscle strength, and thoracic mobility were found between the NSS and RN groups.\u003c/p\u003e \u003cp\u003eBoth surgical procedures (RN and NSS) violate the continuity of skin, subcutaneous and muscular tissue as well as internal organs. In our study, patients operated on by both the sparing and radical methods presented with postoperative scars. In the case of radical nephrectomy, the cut on the surgical sidewas about 25\u0026ndash;30 cm in length as compared to about 10 cm in the case of laparoscopic procedures. Postoperative scarring can result in the reduced range of motion and skin elasticity as well as in tenderness or itching on one side, combined with certain functional limitations such as contractures on the contralateral side [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. In addition, the aesthetics of scars can also translate to psychosocial problems and limited activity of patients. Surgical scar care would be a welcome addition to the overall management regimen. Enhancing the flexibility of scars can have a positive effect on reducing pain, increasing the elasticity of skin, and improving sensations as perceived in the scar area.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eLimitation of mobility in patients having undergone surgical treatment of kidney cancer may be influenced by lack of physical activity. Studies show that patients treated for cancer limit their physical activity [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. As shown by recent reports, regular physical activity should be an integral part of the management of cancer patients. Studies show that regular physical activity can reduce cancer recurrence and improve the quality of life of patients receiving cancer treatment [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIt should be noted that the patients included in this retrospective study had not undergone prehabilitation and postoperative rehabilitation. Scientific reports show that prehabilitation should be a standard constituent of the management of patients preparing for surgery. Patients who have undergone the prehabilitation process are quicker to return to physical fitness after surgery [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Studies show that prehabilitation programs lasting as briefly as 4 weeks are capable of bringing benefitsto cancer patients in terms of reduced hospitalization times and faster postoperative recovery [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, no statistically significant differences were observed in spinal motion range, thoracic mobility, and abdominal strength in patients treated for renal cell carcinoma by means of nephron-sparing surgery vs. radical nephrectomy. No papers by other authors comparing these parameters depending on the extent of the surgery are available in the literature. Less invasive methods are associated with smaller incisions, less pain, and shorter recovery after surgery [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Other authors also point to the lower severity of somatic symptoms such as fatigue or insomnia, as well as to better physical functioning in patients treated with NSS up to 4 years after surgery [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003e6. Study limitation\u003c/h3\u003e\n\u003cp\u003eOur study has certain limitations. One of these consists in the small size of the study sample as well as the lack of randomization. Due to the retrospective nature of the study, it was not possible to assess the baseline levels prior to surgery. Another limitation potentially affecting the results consisted in the composition of the control group, where the majority of subjects were female, with a highly significant difference in gender distribution being noted between the study groups as the result. However, a significant difference in the spinal motion parameters was also observed. The single-center nature of the study should also be listed among the limitations, although, on the other hand, it translated to natural standardization of the results of surgical treatment.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAs shown by the results of our study, patients operated on for kidney cancer present with a reduction in the range of spinal motion, thoracic mobility, and abdominal muscle strength as compared to the control group regardless of the type of surgery performed (nephron-sparing surgery vs. radical nephrectomy).\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments None.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate The research was approved by the Bioethics Committee of the Medical University in Wroclaw. Before participating in the research, each participant signed a consent to participate in the project\u003c/p\u003e\n\u003cp\u003eAuthor Contributions: Conception and design: I.G.-M., M.J., M.T., P.J Collection and assembly of data: I.G.-M., T.N., D.R.-S., A.L. Data analysis and interpretation: M.T., I.G.-M.,.Administrative support: I.G.-M., M.M.-M., B.B., Ł.L., P.P Manuscript writing: I.G.-M. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003eFunding: This research received no external funding.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate:\u0026nbsp;The study was conducted under the ethical standards of the Declaration of Helsinki\u0026nbsp;and approved by the Bioethics Committee at the Nicolaus Copernicus University in Torun (decision no.283/2019).\u0026nbsp;Before participating in the research, each participant signed a consent to participate in the project.\u003c/p\u003e\n\u003cp\u003eConsent for publication Not applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests All authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWojcieszak PZ, Poletajew S, Rutkowski D, Radziszewski, P (2014) The incidence of renal cancer in Polish National Cancer Registry: is there any epidemiological data we can rely on? Cent. European J Urol 67,(3):253-6. \u003c/li\u003e\n\u003cli\u003eFerro M, Musi G, Marchioni M, Maggi M, Veccia A, Del Giudice F, Barone B Crocetto F, Lasorsa, F, Antonelli, A et al. (2023) Radiogenomics in Renal Cancer Management\u0026mdash;Current Evidence and Future Prospects. \u003cem\u003eInt J Mol Sci\u003c/em\u003e \u003cem\u003e24\u003c/em\u003e, 4615. \u003c/li\u003e\n\u003cli\u003eNovara G, Secco S, Botteri, M et al (2010) Factors predicting health-related quality of life recovery in patients undergoing surgical treatment for renal tumors: prospective evaluation using the RAND SF-36 Health Survey Eur Urol 57(1):112\u0026ndash;120. \u003c/li\u003e\n\u003cli\u003eMahedia M, Shah N, Amirlak B (2016) Clinical Evaluation of Hyaluronic Acid Sponge with Zinc versus Placebo for Scar Reduction after Breast Surgery. Plast. Reconstr Surg Glob Open 11;4(7):e791.\u003c/li\u003e\n\u003cli\u003eMiyakoshi N, Itoi E, Kobayashi M, Kodama H (2003) Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis. Osteoporos Int 14:1007\u0026ndash;1012. 4\u003c/li\u003e\n\u003cli\u003eGłowacka-Mrotek I, Jankowski M, Skonieczny B, Tarkowska M, Nowikiewicz T, Leksowski Ł, Dubiel M, Zegarski, W, Mackiewicz-Milewska M (2022) The Impact of Surgical Techniques in Patients with Rectal Cancer on Spine Mobility and Abdominal Muscle Strength-A Prospective Study. Cancers (Basel) 27;14(17):4148.\u003c/li\u003e\n\u003cli\u003eGłowacka-Mrotek I, Tarkowska, M, Jankowski M, Nowikiewicz T, Siedlecki Z, Hagner W, Zegarski W (2020) Prospective evaluation of muscle strength and spine joint motility of patients who underwent surgery for colorectal cancer by open and laparoscopic methods. Videosurgery Miniinv 15 (1): 49\u0026ndash;57\u003c/li\u003e\n\u003cli\u003eLawrence JW, Mason ST, Schomer K, Klein MB (2012) Epidemiology and impact of scarring after burn injury: a systematic review of the literature. J Burn Care Res. 33(1):136-46. \u003c/li\u003e\n\u003cli\u003eGurtner GC, Werner S, Barrandon Y, Longaker MT (2008) Wound repair and regeneration. Nature. 15;453(7193):314-21.\u003c/li\u003e\n\u003cli\u003eCarvalho RL, Alcantara PS, Kamamoto F, et al (2010) Effects oflow-level laser therapy on pain and scar formation afteringuinal herniation surgery: A randomized controlled single-blind study. Photomed Laser Surg 28:417\u0026ndash;422\u003c/li\u003e\n\u003cli\u003eJones LW, Eves ND, Haykowsky M, Freedland SJ, Mackey JR (2009) Exercise intolerance in cancer and the role of exercise therapy to reverse dysfunction. Lancet Oncol. 10(6):598-605. \u003c/li\u003e\n\u003cli\u003eGoode AD, Lawler SP, Brakenridge CL, Reeves MM, Eakin EG (2025) Telephone, print, and Web-based interventions for physical activity, diet, and weight control among cancer survivors: a systematic review. J Cancer Surviv 9: 660\u0026ndash;82\u003c/li\u003e\n\u003cli\u003ePinto BM, Waldemore M, Rosen R (2015) A community-based partnership to promote exercise among cancer survivors: lessons learned. Int J Behav Med. 22(3):328-35. \u003c/li\u003e\n\u003cli\u003eWest MA, Asher R, Browning M, Minto G, Swart M, Richardson K, McGarrity L, Jack S, Grocott MP (2016) Perioperative Exercise Testing and Training Society. Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery. Br J Surg 103(6):744-752. \u003c/li\u003e\n\u003cli\u003eValkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ (2011) The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil 25(2):99-111.\u003c/li\u003e\n\u003cli\u003eDunne DF, Jack S, Jones RP, Jones L, Lythgoe DT, Malik HZ, Poston GJ, Palmer DH, Fenwick SW (2016) Randomized clinical trial of prehabilitation before planned liver resection. Br J Surg 103(5):504-12. \u003c/li\u003e\n\u003cli\u003eGill IS, Kavoussi LR, Lane BR, et al. (2007) Comparison of 1,800 laparoscopic and open partialnephrectomies for single renal tumors. J. Urol 178(1):41\u0026ndash;46. \u003c/li\u003e\n\u003cli\u003eHollenbeck B K, Taub D A, Miller D C, Dunn R L, Wei J T (2006) National utilization trends of partial nephrectomy for renal cell carcinoma: a case of underutilization? Urology 67(2):254\u0026ndash;259.\u003c/li\u003e\n\u003cli\u003eAzawi NH, Tesfalem H, Dahl C, Lund L (2015) Do the different types of renal surgery impact the quality of life in the postoperative period? Int Urol Nephrol. 47(2):263-9. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"renal cell carcinoma, spinalmotion, sparing treatment, radical treatment","lastPublishedDoi":"10.21203/rs.3.rs-5404653/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5404653/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eWith the prolongation of overall survival in patients with renal cell carcinoma, evaluation of the impact of the type of surgical procedure on patients\u0026rsquo;performance status is gaining particular importance. The purpose of this study was to analyze the balance and spinal motion range in patients having undergone total or partial renal resection.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was carried out ina group of patients having received surgical treatment for renal cell carcinoma at the Department of Urology of the Dr. Jan Biziel University Hospital No. 2 in Bydgoszcz 3 to 5 years prior to the inclusion. A total of 31 patients had undergone nephron-sparing surgery [NSS] while another 33 patients had undergone radical nephrectomy [RN]. The control group [CG] consisted of 24 age-range-matched patients. The purpose of the study was to evaluate the range of motion in the spinal joints, thoracic mobility, and abdominal muscle strength.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eStatistical analysis revealed highly significant differences between the study groups as regards the following parameters: total spine flexion (p\u0026thinsp;=\u0026thinsp;0.0001), thoracic spine flexion (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), lumbar spine flexion (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), thoracic mobility (inhalation vs. exhalation) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), rectus and oblique abdominal muscle strength (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). In all the aforementioned parameters, higher scores corresponded to better mobility. Higher scores and better range of motion in spinal joints were observed in the control group. No statistically significant differences between the groups (NSS, RN and CG) were observed in lumbar spine extension (backward inclination) (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eSurgical treatment within the kidneys is associated with reduction in the range of spinal motion, thoracic mobility, and abdominal muscle strength regardless of the type of surgery performed (nephron-sparing surgery vs. radical nephrectomy).\u003c/p\u003e","manuscriptTitle":"Analysis of spinal motion range, thoracic mobility, and abdominal muscle strength in patients operated on for renal cell carcinoma – a pilot, observational cross-sectional study at 3 to 5 years after the surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-24 16:40:48","doi":"10.21203/rs.3.rs-5404653/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4a1cee48-dc9e-456a-bf2f-929e62f971f0","owner":[],"postedDate":"December 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-15T19:08:29+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-24 16:40:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5404653","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5404653","identity":"rs-5404653","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}