Paradigm shift in gastrointestinal surgery − combating sarcopenia with prehabilitation: Multimodal review of clinical and scientific data

Abstract

A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes. These included an increased risk of total complications, major complications, re-admissions, infections, severe infections, 30 d mortality, longer hospital stay and increased hospitalization expenditures. A program to enhance recovery after surgery was meant to address these complications; however, compliance to the program since its introduction has been less than ideal. Over the last decade, the concept of prehabilitation, or “pre-surgery rehabilitation”, has been discussed. The presurgical period represents a window of opportunity to boost and optimize the health of an individual, providing a compensatory “buffer” for the imminent reduction in physiological reserve post-surgery. Initial results have been promising. We review the literature to critically review the utility of prehabilitation, not just in the clinical realm, but also in the scientific realm, with a resource management point-of-view.

Quality is more important than quantity: pre-operative sarcopenia is associated with poor survival in advanced ovarian cancer

“…This novel approach may better reflect the complex association of sarcopenia and cancer allowing for improved pre-operative and oncologic risk stratification. Further, identification of sarcopenia may be useful as the target endpoint of interventions such as prehabilitation 22 23…”

Impact of CT-measured sarcopenic obesity on postoperative outcomes following colon cancer surgery

“…This is crucial as patients undergoing surgical prehabilitation experience benefits such as improved physiology during surgery, reduced complication rates, and lower costs [ 20 ]. While studies on short-term preoperative prehabilitation for sarcopenia exist, research demonstrating tools to improve preoperative SO and their impact on postoperative outcomes is lacking [ 21 , 22 ].…”

Gastric adenocarcinoma with high‑level microsatellite instability: A case report

“…The evolution of surgical technology has made habitual for physicians to perform surgical treatments in gastrointestinal cancer patients with advanced age. However, geriatric patients tend to present a compromised health state due to several factors, including comorbidities, frailty, geriatric syndromes, infections and transfusions, which increase their risk of post-operative complications and death (53). Likewise, it is important to highlight that patients with malnutrition present a higher risk of post-surgical complications including infections and other events (54)(55)(56).…”