Effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery With High Risk for Postoperative Complications: Results of a Randomized Clinical Trial

Berkel, Annefleur E M; Bongers, Bart C.; Kotte, Hayke; Weltevreden, Paul; Jongh, Franciscus H.C. de; Eijsvogel, Michiel; Wymenga, Machteld; Bigirwamungu-Bargeman, Marloes; Palen, Job van der; Det, Marc J. van; Meeteren, N.L.U. van; Klaase, Joost M.

doi:10.1097/sla.0000000000004702

Cited by 175 publications

(215 citation statements)

References 43 publications

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“…We found eleven RCTs assessing the effect of physical exercise in surgical CRC patients over the age of 60 years (mean age range: 60–81 years), with sample sizes from 42 to 185 patients ( Table 3 ). The RCTs included multimodal programs with prehabilitation (before surgery) [ 95 , 96 , 97 , 98 ]. prehabilitation and rehabilitation (after surgery) [ 99 , 100 , 101 ] or comparing prehabilitation vs rehabilitation [ 102 , 103 , 104 , 105 ].…”

Section: Multidisciplinary Team and Comprehensive Interventions In Colorectal Cancer Patientsmentioning

confidence: 99%

“…Programs included exercise training alone [ 95 , 97 , 103 ], exercise training and psychological interventions with anxiety reduction strategies [ 98 , 99 , 102 , 103 , 104 , 105 ], adding in some of them a nutritional control [ 95 , 98 , 99 , 101 , 102 , 103 , 104 , 105 ]. Exercises included aerobic training [ 98 ], aerobic and resistance training [ 95 , 97 , 99 , 100 , 101 , 102 , 103 , 104 , 105 ], or only resistance training [ 96 ]. Aerobic training consisted of activities such as walking, treadmill walking or cycling, following the 150 min/week recommendations by the American College of Sport Medicine Guideline [ 88 , 91 ].…”

Section: Multidisciplinary Team and Comprehensive Interventions In Colorectal Cancer Patientsmentioning

confidence: 99%

“…As shown in Table 3 , the results were variable. Some of the studies demonstrate an increase in functional capacity [ 99 , 104 , 105 ], and others a decrease in postoperative complications [ 95 , 101 ] or LOS [ 100 , 101 ]. Only two RCTs studied mortality, but no decrease was found in 30-day [ 100 ] or 1-year mortality [ 101 ] with the intervention.…”

Section: Multidisciplinary Team and Comprehensive Interventions In Colorectal Cancer Patientsmentioning

confidence: 99%

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Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison

González-Senac

Mayordomo-Cava

Macías-Valle

et al. 2021

IJERPH

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Six out of every 10 new colorectal cancer (CRC) diagnoses are in people over 65 years of age. Current standardized surgical approaches have proved to be tolerable on the elderly population, although post-operative complications are more frequent than in the younger CRC population. Frailty is common in elderly CRC patients with surgical indication, and it appears to be also associated with an increase of post-operative complications. Fast-track pathways have been developed to assure and adequate post-operative recovery, but comprehensive geriatric assessments (CGA) are still rare among the preoperative evaluation of elderly CRC patients. This review provides a thorough study of the effects that a CGA assessment and a geriatric intervention have in the prognosis of CRC elderly patients with surgical indication.

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Section: Multidisciplinary Team and Comprehensive Interventions In Colorectal Cancer Patientsmentioning

confidence: 99%

Section: Multidisciplinary Team and Comprehensive Interventions In Colorectal Cancer Patientsmentioning

confidence: 99%

Section: Multidisciplinary Team and Comprehensive Interventions In Colorectal Cancer Patientsmentioning

confidence: 99%

See 1 more Smart Citation

Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison

González-Senac

Mayordomo-Cava

Macías-Valle

et al. 2021

IJERPH

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“…Prehabilitation programs are designed to optimize the physical and psychological condition of patients undergoing major elective surgery with the final aim to improve clinical outcomes and foster post-surgical functional recovery. The intervention has shown its potential for healthcare value generation in different randomized controlled trials (1)(2)(3)(4)(5). However, despite international experts' endorsements (6-10), its implementation as a standard of care within the Enhanced Recovery After Surgery (ERAS) recommendations ( 11) is still pending.…”

Section: Introductionmentioning

confidence: 99%

Digital Support to Multimodal Community-Based Prehabilitation: Looking for Optimization of Health Value Generation

et al. 2021

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Prehabilitation has shown its potential for most intra-cavity surgery patients on enhancing preoperative functional capacity and postoperative outcomes. However, its large-scale implementation is limited by several constrictions, such as: i) unsolved practicalities of the service workflow, ii) challenges associated to change management in collaborative care; iii) insufficient access to prehabilitation; iv) relevant percentage of program drop-outs; v) need for program personalization; and, vi) economical sustainability. Transferability of prehabilitation programs from the hospital setting to the community would potentially provide a new scenario with greater accessibility, as well as offer an opportunity to effectively address the aforementioned issues and, thus, optimize healthcare value generation. A core aspect to take into account for an optimal management of prehabilitation programs is to use proper technological tools enabling: i) customizable and interoperable integrated care pathways facilitating personalization of the service and effective engagement among stakeholders; ii) remote monitoring (i.e. physical activity, physiological signs and patient-reported outcomes and experience measures) to support patient adherence to the program and empowerment for self-management; and, iii) use of health risk assessment supporting decision making for personalized service selection. The current manuscript details a proposal to bring digital innovation to community-based prehabilitation programs. Moreover, this approach has the potential to be adopted by programs supporting long-term management of cancer patients, chronic patients and prevention of multimorbidity in subjects at risk.

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“…der Wirksamkeit der Vorkonditionierung ist aufgrund weniger randomisierter Studien begrenzt. Eine kürzlich durchgeführte randomisierte, einfach verblindete Studie aus den Niederlanden ergab jedoch, dass die Präkonditionierung die postoperativen Komplikationen bei Hochrisikopatienten, die sich einer onkologischen kolorektalen Resektion unterziehen, signifikant reduzierte[57].…”

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Der Einfluss von Kachexie und Sarkopenie auf das postoperative Outcome

et al. 2021

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ZusammenfassungKachexie wird als multifaktorielles Syndrom definiert, das durch einen unfreiwillig fortschreitenden Gewichtsverlust infolge einer Verringerung der Skelettmuskelmasse mit oder ohne Reduktion des Fettgewebes gekennzeichnet ist. Der Abbau von Muskelgewebe wird als Sarkopenie bezeichnet. Diese wird klinisch als Verlust von Muskelmasse und/oder Muskelkraft definiert, wobei der Verlust von Muskelkraft im Vordergrund steht. Mit Sarkopenie verbunden ist der Zustand der Myosteatose, der durch eine Zunahme der intra- und extrazellulären Fettspeicher gekennzeichnet ist und mit einer verminderten Muskelfunktion einhergeht. Kachexie ist für den Tod von mindestens 20% aller Krebspatienten mitverantwortlich. Die Inzidenz variiert bei diesen Patienten je nach Art der Erkrankung zwischen 80% für Patienten mit Magen- und Bauchspeicheldrüsenkrebs, 50% für Patienten mit Lungen-, Dickdarm- und Prostatakrebs sowie etwa 40% für Patienten mit Brustkrebs oder Leukämie. Hierbei ist eine Unterscheidung zwischen tumorassoziierter Kachexie und einer durch Nebenwirkungen und Komplikationen der onkologischen Therapie bedingten Kachexie oft schwierig. Das wesentliche klinische Merkmal der Kachexie ist ein unfreiwilliger Gewichtsverlust, der sich jedoch nicht immer klinisch manifestiert, sodass die Identifizierung von Risikopatienten erheblich erschwert ist. Nicht nur das Langzeit-Outcome der Patienten wird von Kachexie und Sarkopenie beeinflusst. Auch die unmittelbaren postoperativen Komplikationsraten (Morbidität) werden erhöht und haben tiefgreifende Auswirkungen auf die Krankheitslast und das Leiden der Patienten nach einer chirurgischen Behandlung. Kachexie, Sarkopenie und Myosteatose sind somit für den klinischen Alltag hochrelevante Parameter, die einen signifikanten Einfluss auf das postoperative Outcome der Patienten haben. Es wurden verschiedene Methoden entwickelt, um die frühzeitige Identifizierung von Patienten mit einem erhöhten Risiko zu verbessern. Diese bieten die Möglichkeit, ungewollten Gewichtsverlust, verringerte Muskelkraft und die Fitness der Patienten zu testen. Derartige Maßnahmen sollten Teil unserer täglichen klinischen Routine werden, um diejenigen Patienten mit dem höchsten postoperativen Risiko zu erkennen. Entsprechend können neuartige Präkonditionierungskonzepte für bestimmte Patientengruppen in der Lage sein, die postoperative Morbidität zu verringern.

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Effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery With High Risk for Postoperative Complications: Results of a Randomized Clinical Trial

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Cited by 175 publications

References 43 publications

Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison

Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison

Digital Support to Multimodal Community-Based Prehabilitation: Looking for Optimization of Health Value Generation

Der Einfluss von Kachexie und Sarkopenie auf das postoperative Outcome

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