Response to the Comment on “The Impact of Prehabilitation on Patient Outcomes in Hepatobiliary, Colorectal and Upper Gastrointestinal Cancer Surgery: A PRISMA-Accordant Meta-analysis”

Abstract

complication index, length of stay, risk for surgical reintervention, hospital readmission or any specific type of complications. A grade I complication is either a complication treated with, for example, antiemetics or pain killers or complications not requiring any intervention. Do the authors consider the mild complications prevented by this relatively costly intervention in a highly selected population to motivate the implementation of the intervention in clinical practice, especially in the light of recent reports from larger and more generalizable RCTs?We suggest that the way forward is to evaluate high intensity interventions during at least four weeks and see if the results by Barberan-Garcia et al 3 can be repeated on important postoperative complication before recommendations of preoperative exercise before colorectal cancer surgery should be implemented into clinical routine.

Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

“…Prehabilitation can be defined as the process of ‘optimising physical functionality preoperatively to enable the individual to maintain a normal level of function during and after surgery’. It encompasses a combination of exercise, nutrition and psychosocial interventions [ 41 , 42 ]. A meta-analysis of fifteen studies revealed a significantly lower hospital length of stay in patients undergoing cancer surgery, demonstrating an accelerated post-operative recovery in patients exposed to prehabilitation in the pre-operative period [ 42 ].…”

“…It encompasses a combination of exercise, nutrition and psychosocial interventions [ 41 , 42 ]. A meta-analysis of fifteen studies revealed a significantly lower hospital length of stay in patients undergoing cancer surgery, demonstrating an accelerated post-operative recovery in patients exposed to prehabilitation in the pre-operative period [ 42 ]. To optimise patient outcomes, multidisciplinary collaboration is essential, incorporating opinions from members of the anaesthetic and surgical teams, nursing staff and other allied health professionals [ 40 ].…”

Strategies for optimal perioperative outcomes in gastric cancer

“…19,32,33,35,57,58 For patients with gastrointestinal cancer, Lau and Chamberlain 57 report a 48 meter improvement in the 6MWT distance from baseline to 4-8 weeks postoperatively, and similar trends were observed in a study of patients undergoing esophagogastric cancer resection. 35 As for reducing postoperative complications, prehabilitation appears to provide some protection in mixed surgical cohorts, 19,32 but there is minimal evidence for reduced complications in general, 32 gastrointestinal, 57,59 or esophago-gastric cancer cohorts more specifically. 35 Prehabilitation also appears to reduce length of stay for cancer patients by approximately 2 days, 19,32 though again, this was not always replicated in gastrointestinal cancer cohorts.…”

Ernährung und Bewegung – Das Konzept der Prähabilitation vor großen Tumoroperationen

“…Auch wenn in zwei randomisierten Studien eine signifikante Verminderung der Komplikationen in der Prähabilitationsgruppe und weniger Komplikationen pro Patient gezeigt werden konnten [2,8], spricht die Datenlage aus den Metaanalysen für eine Verbesserung der funktionellen Kapazität, ist jedoch bezüglich des "Outcome" uneinheitlich [9][10][11][12][13]. Dies liegt auch an der bezüglich Durchführung und Intervention erheblichen Heterogenität der Studien.…”