Prehabilitation, making patients fit for surgery – a new frontier in perioperative care

Molenaar, Charlotte J L; Papen-Botterhuis, N.E.; Herrle, Florian; Slooter, Gerrit D.

doi:10.1515/iss-2019-0017

Cited by 28 publications

(23 citation statements)

References 56 publications

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“…Multimodal prehabilitation programs are increasingly implemented into standard care ( 4 ) and a multimodal approach is advised based upon results of this review ( 2 , 3 , 53 ). There are several large RCTs, aiming to recruit between 154 and 1,560 participants, currently in progress that will continue to strengthen this literature base ( 54 – 57 ).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis

et al. 2021

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Objectives: This systematic review set out to identify, evaluate and synthesise the evidence examining the effect of prehabilitation including exercise on postoperative outcomes following abdominal cancer surgery.Methods: Five electronic databases (MEDLINE 1946-2020, EMBASE 1947-2020, CINAHL 1937-2020, PEDro 1999-2020, and Cochrane Central Registry of Controlled Trials 1991-2020) were systematically searched (until August 2020) for randomised controlled trials (RCTs) that investigated the effects of prehabilitation interventions in patients undergoing abdominal cancer surgery. This review included any form of prehabilitation either unimodal or multimodal that included whole body and/or respiratory exercises as a stand-alone intervention or in addition to other prehabilitation interventions (such as nutrition and psychology) compared to standard care.Results: Twenty-two studies were included in the systematic review and 21 studies in the meta-analysis. There was moderate quality of evidence that multimodal prehabilitation improves pre-operative functional capacity as measured by 6 min walk distance (Mean difference [MD] 33.09 metres, 95% CI 17.69–48.50; p = <0.01) but improvement in cardiorespiratory fitness such as preoperative oxygen consumption at peak exercise (VO2 peak; MD 1.74 mL/kg/min, 95% CI −0.03–3.50; p = 0.05) and anaerobic threshold (AT; MD 1.21 mL/kg/min, 95% CI −0.34–2.76; p = 0.13) were not significant. A reduction in hospital length of stay (MD 3.68 days, 95% CI 0.92–6.44; p = 0.009) was observed but no effect was observed for postoperative complications (Odds Ratio [OR] 0.81, 95% CI 0.55–1.18; p = 0.27), pulmonary complications (OR 0.53, 95% CI 0.28–1.01; p = 0.05), hospital re-admission (OR 1.07, 95% CI 0.61–1.90; p = 0.81) or postoperative mortality (OR 0.95, 95% CI 0.43–2.09, p = 0.90).Conclusion: Multimodal prehabilitation improves preoperative functional capacity with reduction in hospital length of stay. This supports the need for ongoing research on innovative cost-effective prehabilitation approaches, research within large multicentre studies to verify this effect and to explore implementation strategies within clinical practise.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis

et al. 2021

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“…46 Recent studies have shown that prehabilitation leads to a reduction of postoperative complications and a faster recovery after surgery. 47 Studies are ongoing in the autologous breast reconstruction setting to determine whether “prehab” targeting of the shoulders, arms, and abdomen to increase range of motion and strength improves postoperative reconstruction outcomes. 48 Prehabilitation is an evolving therapy that seems to be beneficial to breast cancer patients and can help with their overall health, strength, mobility along with an improved sense of self.…”

Section: Prehabilitationmentioning

confidence: 99%

Treatment and Survivorship Interventions to Prevent Poor Body Image Outcomes in Breast Cancer Survivors

Fiser¹,

Crystal²,

Tevis³

et al. 2021

BCTT

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Body image concerns often arise during and after treatment and are a major concern in up to 67% of breast cancer survivors. Negative changes in body image are a predictor of worse satisfaction with appearance and poor quality of life outcomes. Opportunities to mitigate the negative impact of cancer treatment on a patient’s body image present during preoperative education or in the neoadjuvant setting, or during surgical management, adjuvant therapy delivery, and survivorship. The surgical management of breast cancer has evolved from breast amputations to procedures that provide improved cosmesis without compromising the oncologic outcome. The advent of the sentinel lymph node biopsy and lymphatic reconstruction techniques has led to decreased axillary morbidity. Modified radiation techniques and systemic therapies tailored to subtype limit unnecessary exposure to skin and systemic toxicities. Finally, incorporating prehabilitation and survivorship support optimizes the physical and psychosocial well-being of these patients. Setting expectations, treatment de-escalation when appropriate, morbidity risk reduction and improved screening and management of psychological sequelae during survivorship can decrease breast cancer treatment’s negative impact on body image. The following review synthesizes interventions during preoperative planning, local and systemic treatment, and survivorship to prevent poor body image outcomes without compromising oncologic success.

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“…Gerade die "nichtchirurgischen Komplikationen" nach einer Operation steigen mit einem Alter > 75 Jahre [15] deutlich an. Es muss daher ein besonderes Augenmerk auf die Prähabilitation [16] und das postoperative Prozedere (ERAS -Enhanced Recovery After Surgery) gelegt werden. Dazu gehören insbesondere eine verbesserte Mobilisation und Atemtraining vor der Operation, ein minimalinvasives Operationsverfahren und ein multimodales Konzept nach der Operation [17].…”

Section: Chirurgische Therapieunclassified

Gastrointestinale Tumoren beim älteren und alten Patienten

Schulte

Ebert

Reißfelder³

et al. 2020

Z Gastroenterol

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ZusammenfassungÄltere Patienten (65 Jahre und älter) stellen die Mehrheit der Patienten mit einer Krebsdiagnose dar. Für Ösophaguskarzinome liegt der Altersgipfel in der siebten bis achten Lebensdekade. Bei Magenkarzinomen ist 1/3 der Patienten älter als 75 Jahre, und ca. 45 % der Kolonkarzinom-Patienten sind ≥ 75 Jahre alt.Aufgrund bestehender Komorbiditäten, altersbedingter Veränderungen und Polypharmazie stellen ältere und alte Patienten eine besondere Herausforderung in der Tumortherapie dar.In Studien sind diese Patienten meist deutlich unterrepräsentiert, und dezidierte „Elderly“-Studien sind rar. Neue Operationsverfahren mit der minimalinvasiven Technik wie der Laparoskopie oder mit Telemanipulatoren liefern gerade für das Ösophagus- und Magenkarzinom Vorteile, die zukünftig für alte und ältere Patienten die postoperative Morbidität in Bezug auf kardiale und pulmonale Komplikationen deutlich senken können.Bezüglich Chemotherapie zeigt sich eine gute Verträglichkeit von Fluoropyrimidinen und Oxaliplatin; von Triple-Therapien sollte eher Abstand genommen werden. Gerade die Immuntherapie bietet aufgrund des besseren Nebenwirkungsprofils eine interessante Alternative zur Standardchemotherapie.

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Prehabilitation, making patients fit for surgery – a new frontier in perioperative care

Cited by 28 publications

References 56 publications

Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis

Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis

Treatment and Survivorship Interventions to Prevent Poor Body Image Outcomes in Breast Cancer Survivors

Gastrointestinale Tumoren beim älteren und alten Patienten

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