Login

ISEO – Inaugural Conference July 22nd & 23rd 2026 - organized by DKFZ

22–23 Jul 2026
Heidelberg Congress Center
Europe/Berlin timezone

Organizing Team

Preoperative Metabolic Inflexibility Predicts Impaired Plasma Metabolite Clearance Following Radical Cystectomy

23 Jul 2026, 11:45
1h 15m
Heidelberg Congress Center ( Heidelberg Congress Center )

Heidelberg Congress Center

Heidelberg Congress Center

Czernyring 20 69115 Heidelberg Germany
1 - Scientific Poster Poster Session

Speaker

Mr Thomas Boucher ((1) Hawkes Institute, UCL, London, UK, (2) Department of Medical Physics and Biomedical Engineering, UCL, London, UK, (3) Human Physiology and Performance Laboratory (HPPL), Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, UCL, London, UK)

Description

Introduction:
Metabolic flexibility is a key determinant of physiological resilience and predictor of complications following radical cystectomy. We hypothesize that the change in the metabolomic profile of cystectomy patients throughout the perioperative period is associated with metabolic flexibility, as determined by preoperative carbohydrate oxidation (CHOox) (g/min).

Methods:
We retrospectively analysed changes in 538 plasma metabolites pre-to-post cystectomy (three-month interval) in N = 17 adult patients from an IRB-approved study (Duke IRB Pro00103570) who underwent preoperative CPET. Metabolites were measured using the MxP Quant 500 kit (Biocrates, Innsbruck, AUT). CHOox was derived from CPET measurements using standardised nonprotein respiratory exchange ratios, with AUC calculated to anaerobic threshold. Patients were stratified by median split into high and low CHOox AUC groups (n = 8, n = 9). Differential metabolite changes were assessed using Mann-Whitney U tests with exploratory FDR correction (q < 0.2).

Results:
For all ten significant metabolites (q < 0.2), low CHOox capacity was associated with longitudinal metabolite differences, and increases in concentrations. Median lactate (+0.63-fold vs -0.78-fold, q = 0.1402, low vs high CHOox) and glutamate (+0.25-fold vs -0.29-fold, q = 0.1992) reflect changes in carbohydrate oxidation. Long-chain acylcarnitines C16 (+0.23-fold vs -0.15-fold), C18:1 (+0.23-fold vs -0.13-fold), C18:2 (+0.17-fold vs -0.09-fold) (q = 0.1402) indicate changes in fatty acid oxidation and mitochondrial fat transport. Lysophosphatidylcholines C16:0 (+0.73-fold vs -0.71-fold, q = 0.1475), C17:0 (+0.38-fold vs -0.49-fold, q = 0.1475), C18:0 (+0.66-fold vs -0.78-fold, q = 0.1402) and glycosylceramides Hex2Cer d18:1/24:1 (+0.06-fold vs -0.09-fold, q = 0.1402), d18:1/24:0 (+0.02-fold vs -0.08-fold, q = 0.1475) reflect alterations in lipid processing and tissue uptake.

Conclusion:
Low preoperative CHOox predicts persistent metabolite accumulation across multiple pathways, indicating sustained and worsened substrate processing deficits following cystectomy. This identifies metabolic inflexibility as a mechanistic driver of perioperative dysfunction and a specific prehabilitation target.

Keywords

Metabolic Flexibility, Carbohydrate Oxidation, Plasma Metabolites, Prehabilitation

Abstract submitters declaration yes
Conflict of Interest & Ethical Approval yes

Author

Mr Thomas Boucher ((1) Hawkes Institute, UCL, London, UK, (2) Department of Medical Physics and Biomedical Engineering, UCL, London, UK, (3) Human Physiology and Performance Laboratory (HPPL), Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, UCL, London, UK)

Co-authors

Mr Nicholas Tetlow ((3) Human Physiology and Performance Laboratory (HPPL), Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, UCL, London, UK, (4) Department of Anaesthesia and Peri-operative Medicine, University College London Hospitals NHS Foundation Trust, London, UK) Dr Zachary Healy ((5) Department of Medicine, Duke University School of Medicine, Durham, NC, USA) Dr David Macleod ((5) Department of Medicine, Duke University School of Medicine, Durham, NC, USA) Dr Jeroen Molinger ((5) Department of Medicine, Duke University School of Medicine, Durham, NC, USA) Prof. Brant Inman ((6) Division of Urology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA) Dr John Whittle ((1) Hawkes Institute, UCL, London, UK, (3) Human Physiology and Performance Laboratory (HPPL), Division of Surgery and Interventional Science, Department of Targeted Intervention, Centre for Peri-operative Medicine, UCL, London, UK (4) Department of Anaesthesia and Peri-operative Medicine, University College London Hospitals NHS Foundation Trust, London, UK) Dr Evangelos B. Mazomenos ((1) Hawkes Institute, UCL, London, UK (2) Department of Medical Physics and Biomedical Engineering, UCL, London, UK)

Presentation materials

There are no materials yet.