Perioperative Factors Associated With Early Postdischarge Six-Minute Walk Distance After Gastrointestinal Cancer Surgery: An Exploratory Prospective Cohort Study

Background: Recovery after discharge is a key goal of cancer rehabilitation in patients undergoing gastrointestinal cancer surgery; however, perioperative factors associated with early postdischarge 6-minute walk distance (6MWD) remain unclear. This exploratory prospective cohort study aimed to identify perioperative factors associated with 6MWD approximately 1 month after discharge. Methods: This exploratory prospective cohort study used convenience sampling and included 27 patients who underwent gastric or colorectal cancer surgery. Assessments were conducted preoperatively, at discharge, and during the early postdischarge period. The primary outcome was the 6MWD measured during the early postdischarge period. Candidate factors included demographic and clinical variables, physical function, cancer-related fatigue, instrumental activities of daily living, and albumin. Accelerometer-derived physical activity variables were examined as secondary exploratory measures. Exploratory multivariable linear regression analyses were performed separately for preoperatively (PRE) and at discharge (DIS) models, and Bayesian linear regression was conducted as a complementary analysis. Results: The 6MWD improved after discharge, increasing by 40.4 m from discharge to the early postdischarge assessment, indicating a clinically meaningful recovery. In the DIS model, discharge 6MWD was positively associated with postdischarge 6MWD, whereas age was negatively associated, and postoperative complications showed a negative trend. In the PRE model, preoperative 6MWD was positively associated with postdischarge 6MWD, whereas preoperative mental fatigue was negatively associated. It improved after discharge, increasing by 40.4 m from discharge to the early postdischarge assessment, indicating a clinically meaningful recovery. In the DIS model, discharge 6MWD was positively associated with postdischarge 6MWD, whereas age was negatively associated and postoperative complications showed a negative trend. In the PRE model, preoperative 6MWD was positively associated with postdischarge 6MWD, whereas preoperative mental fatigue was negatively associated. Conclusions: Early postdischarge 6MWD was associated with perioperative functional capacity, age, and preoperative mental fatigue. These exploratory findings should be interpreted cautiously and may help refine perioperative assessment and postdischarge support strategies.