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Sathe SV, Huang Y, Zarate Rodriguez JG, Cos H, Cook J, Koenen M, Chapman WC, Kozower BD, Fields RC, Sanford DE. The benefits of a department-wide prehabilitation program: A propensity score match analysis. Surgery 2025; 184:109489. [PMID: 40513208 DOI: 10.1016/j.surg.2025.109489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 05/03/2025] [Accepted: 05/16/2025] [Indexed: 06/16/2025]
Abstract
BACKGROUND Despite increasing use of prehabilitation in aging surgical patients, large studies demonstrating benefits on postoperative outcomes are lacking. This study aimed to determine if a department-wide prehabilitation program (Surgical Prehabilitation and Readiness) improves 30-day mortality, discharge to post-acute care facilities, and postoperative length of stay in high-risk surgical patients compared to historical controls, and to examine age's influence on these outcomes. METHODS Surgical Prehabilitation and Readiness patients with 30 days of postoperative follow-up were compared to patients from the National Surgical Quality Improvement Program database undergoing procedures at the same institution during the 5 years before Surgical Prehabilitation and Readiness implementation (pre-Surgical Prehabilitation and Readiness). Surgical Prehabilitation and Readiness patients were propensity score matched to pre-Surgical Prehabilitation and Readiness patients in a 1:3 ratio, and outcomes were compared. RESULTS Over 40 months, 424 patients completed Surgical Prehabilitation and Readiness and underwent surgery with 30 days of follow-up. Compared with pre-Surgical Prehabilitation and Readiness patients, Surgical Prehabilitation and Readiness patients were significantly older (median: 69.9 vs 60.7 years, P < .001) with higher American Society of Anesthesiologists class (≥3: 84.7% vs 54.4%, P < .001) and more comorbidities. Compared to propensity score-matched pre-Surgical Prehabilitation and Readiness patients (n = 1,161), Surgical Prehabilitation and Readiness patients (n = 387) had significantly decreased 30-day mortality (0.8% vs 2.8%, P = .023), discharge to post-acute care facility (8.8% vs 12.9%, P = .030), and length of stay (7.2 vs 8.0 days, P = .039). Older Surgical Prehabilitation and Readiness patients (age > median) exhibited significantly decreased 30-day mortality (0.6% vs 3.3%, P = .044) and discharge to post-acute care facility (11.6% vs 19.3%, P = .017), whereas younger Surgical Prehabilitation and Readiness patients (age ≤ median) exhibited decreased length of stay (6.9 vs 8.2 days, P = .021). CONCLUSIONS Prehabilitation reduces postoperative mortality, loss of functional independence, and hospital recovery time, and the benefits vary by age. These findings support the implementation of prehabilitation programs in clinical practice.
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Affiliation(s)
- Shaleen V Sathe
- Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO.
| | - Yijin Huang
- Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO
| | - Jorge G Zarate Rodriguez
- Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO
| | - Heidy Cos
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Jennifer Cook
- Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO
| | - Melanie Koenen
- Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO
| | - William C Chapman
- Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO; Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO
| | - Benjamin D Kozower
- Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO; Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO; Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, Saint Louis, MO; Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO
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Wang Z, Li J, Zhang Q, Chen X. Comparative Effectiveness of Different Prehabilitation Strategies in Patients Undergoing Digestive System Cancer Surgery: A Network Meta-Analysis. J Gastrointest Surg 2025:102119. [PMID: 40513812 DOI: 10.1016/j.gassur.2025.102119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2025] [Revised: 06/04/2025] [Accepted: 06/07/2025] [Indexed: 06/16/2025]
Abstract
OBJECTIVE This network meta-analysis evaluated the efficacy of different prehabilitation modalities for patients undergoing digestive system cancer surgery. METHODS A systematic search of PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, and Web of Science was conducted from inception to March 1, 2025. Randomized controlled trials assessing exercise-based (EX), nutrition-based (NU), or multimodal (Mul) prehabilitation were included. Primary clinical outcomes were length of hospital stay (LOS) and postoperative complications, while functional outcomes included 6-minute walking distance (6MWD), anxiety, depression, and quality of life (QoL). Pairwise meta-analyses estimated mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CIs). A network meta-analysis was performed to rank interventions using surface under the cumulative ranking (SUCRA) probabilities. RESULTS Twenty-six RCTs involving 2042 patients were included. Pairwise meta-analyses showed that prehabilitation significantly reduced LOS (MD = -1.12, 95%CI = -1.99, -0.26) and postoperative complications (OR = 0.71, 95%CI = 0.59, 0.86), while improving 6MWD (MD = 35.59, 95%CI = 20.47, 50.72) and QoL (MD = 5.96, 95%CI = 2.00, 9.92). Subgroup analyses indicated that gastric cancer patients benefited more in terms of complication reduction. The network meta-analysis ranked EX as the most effective for reducing postoperative complications (SUCRA = 88.9%), followed by Mul (SUCRA = 74.0%). For functional outcomes, EX ranked highest for postoperative 6MWD improvement (SUCRA = 81.0%), while Mul was superior in improving presurgery 6MWD (SUCRA = 74.9%), QoL (SUCRA = 99.2%), and depressive symptoms (SUCRA = 87.9%). CONCLUSION Prehabilitation, particularly EX and Mul, effectively reduces postoperative complications and enhances functional recovery in digestive system cancer surgery. Clinicians should consider patient-specific factors when selecting prehabilitation strategies. Future research should standardize intervention protocols and outcome measures to optimize perioperative care.
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Affiliation(s)
- Zhenzi Wang
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Jiaqi Li
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Qian Zhang
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xiaomeng Chen
- Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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Ljungqvist O. Managing surgical stress: Principles of enhanced recovery and effect on outcomes. Clin Nutr ESPEN 2025; 67:56-61. [PMID: 40058494 DOI: 10.1016/j.clnesp.2025.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Accepted: 02/20/2025] [Indexed: 03/14/2025]
Affiliation(s)
- Olle Ljungqvist
- Karolinska Institutet & Örebro University, Sweden; School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden; Department of Surgery, Örebro University Hospital, SE-701 85 Örebro, Sweden.
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Barman S, Russell B, Walker RC, Knight W, Baker C, Kelly M, Gossage J, Zylstra J, Whyte G, Pate J, Lagergren J, Van Hemelrijck M, Browning M, Allen S, Preston SR, Sultan J, Singh P, Rockall T, Robb WB, Tully R, Loughney L, Bolger J, Sorensen J, Collins CG, Carroll PA, Timon CM, Arumugasamy M, Murphy T, McCaffrey N, Grocott M, Jack S, Levett DZH, Underwood TJ, West MA, Davies AR. The Impact of Prehabilitation on Patient Outcomes in Oesophagogastric Cancer Surgery: Combined Data from Four Prospective Clinical Trials Performed Across the UK and Ireland. Cancers (Basel) 2025; 17:1836. [PMID: 40507316 PMCID: PMC12153824 DOI: 10.3390/cancers17111836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2025] [Revised: 05/15/2025] [Accepted: 05/24/2025] [Indexed: 06/16/2025] Open
Abstract
BACKGROUND Prehabilitation is increasingly being used in patients undergoing multimodality treatment for oesophagogastric cancer (OGC). Most studies to date have been small, single-centre trials. This collaborative study sought to assess the overall impact of prehabilitation on patient outcomes following OGC surgery. METHODS Data came from four prospective prehabilitation trials conducted in the UK or Ireland in patients undergoing multimodality treatment for OGC. The studies included three randomised and one non-randomised clinical trial, each comparing a prehabilitation intervention group to controls. The prehabilitation interventions included aerobic training delivered by exercise physiologists alongside dietetic input throughout the treatment pathway. The primary outcome was survival (all-cause and disease-specific mortality). Secondary outcomes were differences in complications, cardio-respiratory fitness (changes in VO2 peak and anaerobic threshold (AT)), chemotherapy completion rates, hospital length of stay, changes in body mass index, tumour regression and complication rates of anastomotic leak and pneumonia. Cox and logistic regression analysis provided hazard ratios (HR) and odds ratios (OR), respectively, with 95% confidence intervals (CI), adjusted for confounders. RESULTS Among 165 patients included, 88 patients were in the prehabilitation group and 77 patients were in the control group. All-cause and disease-specific mortality were not improved by prehabilitation (HR 0.67 95% CI 0.21-2.12 and HR 0.82 95% CI 0.42-1.57, respectively). The prehabilitation group experienced fewer major complications (20% vs. 36%, p = 0.034; adjusted OR of 0.54; 95%CI 0.26-1.13). There was a mitigated decline in VO2 peak following neo-adjuvant therapy (delta prehabilitation -1.07 mL/kg/min vs. control -2.74 mL/kg/min; p = 0.035) and chemotherapy completion rates were significantly higher following prehabilitation (90% vs. 73%; p = 0.016). Hospital length of stay (10 vs. 12 days, p = 0.402) and neoadjuvant chemotherapy response (Mandard 1-3 41% vs. 35%; p = 0.494) favoured prehabilitation, albeit not statistically significantly. CONCLUSION Despite some limitations in terms of heterogeneity of study methodology, this study suggests a number of meaningful clinical benefits from prehabilitation before surgery for OGC patients. Current initiatives to agree on national standards for delivering prehabilitation and the results of ongoing trials will help to further refine this important intervention and expand the evidence base to support the widespread adoption and implementation of prehabilitation programs.
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Affiliation(s)
- Sowrav Barman
- Guy’s & St Thomas’ Oesophago-Gastric Centre, London SE1 7EH, UK; (W.K.); (C.B.); (M.K.); (J.G.); (J.Z.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, London WC2R 2LS, UK;
| | - Beth Russell
- Transforming Cancer OUtcomes Through Research (TOUR), School of Cancer & Pharmaceutical Sciences, King’s College London, London WC2R 2LS, UK; (B.R.); (M.V.H.)
| | - Robert C. Walker
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (R.C.W.); (T.J.U.); (M.A.W.)
- Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK; (S.A.); (S.R.P.); (P.S.); (T.R.)
| | - William Knight
- Guy’s & St Thomas’ Oesophago-Gastric Centre, London SE1 7EH, UK; (W.K.); (C.B.); (M.K.); (J.G.); (J.Z.)
| | - Cara Baker
- Guy’s & St Thomas’ Oesophago-Gastric Centre, London SE1 7EH, UK; (W.K.); (C.B.); (M.K.); (J.G.); (J.Z.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, London WC2R 2LS, UK;
| | - Mark Kelly
- Guy’s & St Thomas’ Oesophago-Gastric Centre, London SE1 7EH, UK; (W.K.); (C.B.); (M.K.); (J.G.); (J.Z.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, London WC2R 2LS, UK;
| | - James Gossage
- Guy’s & St Thomas’ Oesophago-Gastric Centre, London SE1 7EH, UK; (W.K.); (C.B.); (M.K.); (J.G.); (J.Z.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, London WC2R 2LS, UK;
| | - Janine Zylstra
- Guy’s & St Thomas’ Oesophago-Gastric Centre, London SE1 7EH, UK; (W.K.); (C.B.); (M.K.); (J.G.); (J.Z.)
- Research Institute for Sport and Exercise Sciences (RISES), Liverpool John Moores University, Liverpool L3 3AF, UK;
| | - Greg Whyte
- Research Institute for Sport and Exercise Sciences (RISES), Liverpool John Moores University, Liverpool L3 3AF, UK;
| | - James Pate
- Marylebone Health Group, London W1G 7HH, UK;
| | - Jesper Lagergren
- School of Cancer & Pharmaceutical Sciences, King’s College London, London WC2R 2LS, UK;
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, SE 17176 Stockholm, Sweden
| | - Mieke Van Hemelrijck
- Transforming Cancer OUtcomes Through Research (TOUR), School of Cancer & Pharmaceutical Sciences, King’s College London, London WC2R 2LS, UK; (B.R.); (M.V.H.)
| | - Mike Browning
- Maidstone and Tunbridge Wells NHS Trust, Maidstone ME16 9QQ, UK;
| | - Sophie Allen
- Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK; (S.A.); (S.R.P.); (P.S.); (T.R.)
| | - Shaun R. Preston
- Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK; (S.A.); (S.R.P.); (P.S.); (T.R.)
- Faculty of Health and Medical Sciences, School of Medicine, University of Surrey, Guildford GU2 7AL, UK
| | - Javed Sultan
- Manchester Academic Health Science Centre, University of Manchester, Manchester M13 9PL, UK;
- Department of Oesophago-Gastric & Bariatric Surgery, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford M6 8HD, UK
| | - Pritam Singh
- Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK; (S.A.); (S.R.P.); (P.S.); (T.R.)
| | - Timothy Rockall
- Royal Surrey NHS Foundation Trust, Guildford GU2 7XX, UK; (S.A.); (S.R.P.); (P.S.); (T.R.)
| | - William B. Robb
- Department of Upper GI Surgery, Beaumont Hospital, D09 V2N0 Dublin, Ireland; (W.B.R.); (R.T.); (J.B.); (M.A.)
- Department of Surgery, Royal College of Surgeons in Ireland, St. Stephen’s Green, D02 YN77 Dublin, Ireland; (L.L.); (J.S.)
| | - Roisin Tully
- Department of Upper GI Surgery, Beaumont Hospital, D09 V2N0 Dublin, Ireland; (W.B.R.); (R.T.); (J.B.); (M.A.)
- Department of Surgery, Royal College of Surgeons in Ireland, St. Stephen’s Green, D02 YN77 Dublin, Ireland; (L.L.); (J.S.)
| | - Lisa Loughney
- Department of Surgery, Royal College of Surgeons in Ireland, St. Stephen’s Green, D02 YN77 Dublin, Ireland; (L.L.); (J.S.)
- ExWell Medical, c/o Irish Wheelchair Association, Blackheath Drive, D03 AW62 Dublin, Ireland;
| | - Jarlath Bolger
- Department of Upper GI Surgery, Beaumont Hospital, D09 V2N0 Dublin, Ireland; (W.B.R.); (R.T.); (J.B.); (M.A.)
- Department of Surgery, Royal College of Surgeons in Ireland, St. Stephen’s Green, D02 YN77 Dublin, Ireland; (L.L.); (J.S.)
| | - Jan Sorensen
- Department of Surgery, Royal College of Surgeons in Ireland, St. Stephen’s Green, D02 YN77 Dublin, Ireland; (L.L.); (J.S.)
| | - Chris G. Collins
- Department of Surgery, University Hospital Galway, H91 YR71 Galway, Ireland;
| | - Paul A. Carroll
- Department of Surgery, Sligo University Hospital, F91 H684 Sligo, Ireland;
| | - Claire M. Timon
- School of Population Health, RCSI University of Medicine and Health Sciences, D09 YD60 Dublin, Ireland;
| | - Mayilone Arumugasamy
- Department of Upper GI Surgery, Beaumont Hospital, D09 V2N0 Dublin, Ireland; (W.B.R.); (R.T.); (J.B.); (M.A.)
- Department of Surgery, Royal College of Surgeons in Ireland, St. Stephen’s Green, D02 YN77 Dublin, Ireland; (L.L.); (J.S.)
| | - Thomas Murphy
- Department of Surgery, Mercy University Hospital, T12 WE28 Cork, Ireland;
| | - Noel McCaffrey
- ExWell Medical, c/o Irish Wheelchair Association, Blackheath Drive, D03 AW62 Dublin, Ireland;
| | - Mike Grocott
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University Hospital Southampton NHS Foundation Trust, Southampton SO16 7QF, UK; (M.G.); (S.J.); (D.Z.H.L.)
- Integrative Physiology and Critical Illness Group, School of Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Sandy Jack
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University Hospital Southampton NHS Foundation Trust, Southampton SO16 7QF, UK; (M.G.); (S.J.); (D.Z.H.L.)
- Integrative Physiology and Critical Illness Group, School of Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Denny Z. H. Levett
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University Hospital Southampton NHS Foundation Trust, Southampton SO16 7QF, UK; (M.G.); (S.J.); (D.Z.H.L.)
- Integrative Physiology and Critical Illness Group, School of Clinical and Experimental Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Tim J. Underwood
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (R.C.W.); (T.J.U.); (M.A.W.)
| | - Malcolm A. West
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (R.C.W.); (T.J.U.); (M.A.W.)
- NIHR Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University Hospital Southampton NHS Foundation Trust, Southampton SO16 7QF, UK; (M.G.); (S.J.); (D.Z.H.L.)
| | - Andrew R. Davies
- Guy’s & St Thomas’ Oesophago-Gastric Centre, London SE1 7EH, UK; (W.K.); (C.B.); (M.K.); (J.G.); (J.Z.)
- School of Cancer & Pharmaceutical Sciences, King’s College London, London WC2R 2LS, UK;
- Department of Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, SE 17176 Stockholm, Sweden
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Sier MAT, Godina E, Mollema O, Cox MPPJ, Tweed TTT, Greve JW, Stoot JHMB. Participation and Adherence to Prehabilitation Programs for Colorectal Cancer. Nutrients 2025; 17:1792. [PMID: 40507060 PMCID: PMC12157972 DOI: 10.3390/nu17111792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2025] [Revised: 05/15/2025] [Accepted: 05/19/2025] [Indexed: 06/16/2025] Open
Abstract
Background/Objectives: The preoperative improvement of patients' functional capacity (prehabilitation) has gained attention in the surgical field, especially for colorectal cancer (CRC) patients. Despite the recognized benefits of prehabilitation programs, patients' motivation to participate in and adhere to them remains a significant challenge. Several studies reported difficulties in recruiting participants and low adherence rates. This systematic review explored patients' motivation for participation and adherence to prehabilitation programs for colorectal cancer surgery. Methods: A systematic search was conducted in the PubMed (MEDLINE), Embase, Cochrane, CINAHL, and Web of Science databases. Eligible studies included clinical trials published from inception until December 2024, written in English or Dutch, describing barriers and/or motivators affecting patient participation and adherence in prehabilitation programs. Results: A total of 89 studies, including 34 randomized controlled trials, were included. In total, 13,383 patients were included, with 7162 in the prehabilitation cohort. Participation rates ranged from 0 to 99.4%, and adherence rates ranged from 15% to 100%. Factors limiting participation included logistical issues and a busy schedule. Professional guidance, peer support, and regaining a sense of control improved adherence. Medical reasons, conflicting obligations, and intensive exercise limited adherence. Conclusions: This systematic review analyzed the current literature on participation and adherence in prehabilitation programs for colorectal cancer surgery patients. Overcoming logistical barriers and patient concerns through flexible, patient-centered approaches may improve participation and adherence. Future research should focus on large-scale randomized controlled trials, diverse healthcare settings, and strategies to enhance engagement with prehabilitation programs.
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Affiliation(s)
- Misha A. T. Sier
- Department of Surgery, Zuyderland Medical Centre, 6162 BG Sittard, The Netherlands; (J.W.G.); (J.H.M.B.S.)
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Eva Godina
- Faculty of Health, Medicine and Life Science, Maastricht University Medical Center+, 6229 ER Maastricht, The Netherlands; (E.G.)
| | - Omar Mollema
- Faculty of Health, Medicine and Life Science, Maastricht University Medical Center+, 6229 ER Maastricht, The Netherlands; (E.G.)
| | - Maud P. P. J. Cox
- Department of Internal Medicine, Máxima Medical Centre, 5504 DB Veldhoven, The Netherlands;
| | - Thais T. T. Tweed
- Department of Surgery, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands;
| | - Jan Willem Greve
- Department of Surgery, Zuyderland Medical Centre, 6162 BG Sittard, The Netherlands; (J.W.G.); (J.H.M.B.S.)
| | - Jan H. M. B. Stoot
- Department of Surgery, Zuyderland Medical Centre, 6162 BG Sittard, The Netherlands; (J.W.G.); (J.H.M.B.S.)
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Moyen A, Fleurent-Grégoire C, Gillis C, Zaks R, Carli F, Scheede-Bergdahl C, Spicer J, Cools-Lartigue J, Najmeh S, Morais JA, Mazurak V, Chevalier S. Novel multimodal intervention for surgical prehabilitation on functional recovery and muscle characteristics in patients with non-small cell lung cancer: study protocol for a randomised controlled trial (MMP-LUNG). BMJ Open Respir Res 2025; 12:e002884. [PMID: 40404185 PMCID: PMC12097010 DOI: 10.1136/bmjresp-2024-002884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 04/28/2025] [Indexed: 05/24/2025] Open
Abstract
INTRODUCTION Lung cancer is the leading cause of cancer-related deaths. Patients with stage I-III non-small cell lung cancer (NSCLC) are candidates for surgical resection; however, patients with low muscle mass, myosteatosis, malnutrition or reduced functional capacity preoperatively have a higher risk of postoperative morbidity. Prehabilitation is a care process aiming to enhance functional capacity before surgery to improve surgical outcomes. Study objectives are to test the effect of prehabilitation interventions of a mixed-nutrient supplement (NUT) alone or its combination with exercise (MM, multimodal prehabilitation), compared with placebo-control (CTL), in NSCLC patients on change in functional capacity pre-surgery and post-discharge, muscle mass and myosteatosis, postoperative health-related quality of life (HRQoL), complications and length of hospital stay. We hypothesise that a multi-nutrient supplement, with or without exercise, will be of benefit. METHODS AND ANALYSIS Randomised controlled trial of three parallel arms: 168 patients with operable NSCLC at nutritional risk are randomised 1:1:1 to CTL, NUT or MM. Patients in the NUT and MM groups receive a nutritional supplement consisting of whey protein, leucine, vitamin D and fish oil 4-6 weeks preoperatively and 6 weeks post-discharge. The exercise programme (MM) consists of daily moderate-intensity aerobic activity and resistance training 3 days/week. The following is assessed at baseline, preoperatively and week six post-discharge: functional capacity using the 6 min walk test, muscle mass and myosteatosis using D3-creatine dilution and peripheral quantitative CT, and HRQoL using the Functional Assessment of Cancer Therapy-Lung. Intention-to-treat analysis of covariance will compare between-group differences adjusted for baseline variables. Postoperative functional recovery will be tested by logistic regression. Between-group differences in clinical outcomes will be tested, applying Bonferroni correction. ETHICS AND DISSEMINATION This trial is approved by the McGill University Health Centre Research Ethics Board (2022-7782). Results will be published in open-access peer-reviewed journals and conference presentations. TRIAL REGISTRATION DETAILS NCT05955248.
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Affiliation(s)
- Audrey Moyen
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Chloé Fleurent-Grégoire
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
- Departments of Anesthesia & Surgery, McGill University, Montreal, Quebec, Canada
| | - Roni Zaks
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Surgical and Interventional Sciences, McGill University, Montreal, Quebec, Canada
| | - Francesco Carli
- Departments of Anesthesia & Surgery, McGill University, Montreal, Quebec, Canada
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada
| | - Jonathan Spicer
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Jonathan Cools-Lartigue
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Sara Najmeh
- McGill University Health Centre, Montreal, Quebec, Canada
| | - José A Morais
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Vera Mazurak
- Division of Human Nutrition, Department of Agricultural, Food and Nutritional Science, Li Ka Shing Centre for Health Research Innovation, Edmonton, Alberta, Canada
| | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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Silva FSDS, Lima GBB, Lima GSDCE, Torres DC, Macedo MM, Amorim CEN. Effects of Mobilization Within 24 Hours Based on the ICU Mobility Scale in Cancer Patients: A Randomized Controlled Clinical Trial "Mobilization Based on the ICU Mobility Scale". J Surg Oncol 2025. [PMID: 40358360 DOI: 10.1002/jso.28142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 01/25/2025] [Accepted: 02/19/2025] [Indexed: 05/15/2025]
Abstract
BACKGROUND AND OBJECTIVE Abdominal cancer surgery leads to loss of functional capacity. The objective was to evaluate the effects of mobilization within 24 h applied to patients with abdominal neoplasms undergoing major surgery. METHODS A randomized controlled clinical trial was carried out in the Intensive Care Unit. The intervention group performed mobility activities guided by the ICU mobility scale (IMS) in the first 24 h after surgery and the control group performed conventional physiotherapy. Dynamometry was evaluated in the preoperative, 1st POD and postoperative period, as well as the Timed up and go test (TUG). RESULTS Patients in the intervention group had greater initial mobility (IMS Scale intervention group: 6.67 ± 0.69; IMS Scale control group: 2.23 ± 0.52; p = 0.001). There was greater level of mobility until discharge from the ICU in patients in the intervention group compared to the control group (IMS at discharge from the ICU in the intervention group: 8.53 ± 0.33; IMS at discharge from the ICU in the control group: 3 ± 0.64). Both groups showed worsening in the TUG test, but it was significant only in the control group. CONCLUSION Early mobilization in patients with abdominal neoplasms undergoing major surgery proved to be effective in maintaining mobility and functional markers.
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Suárez-Alcázar MP, Folch Ayora A, Muriach M, Recacha-Ponce P, Garcia-Roca ME, Coret-Franco A, Pastor-Mora JC, Salas-Medina P, Collado-Boira EJ. Multimodal Prehabilitation in Colorectal Cancer: Improving Fitness, Lifestyle, and Post-Surgery Outcomes. Healthcare (Basel) 2025; 13:1083. [PMID: 40361861 PMCID: PMC12071798 DOI: 10.3390/healthcare13091083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 04/29/2025] [Accepted: 05/05/2025] [Indexed: 05/15/2025] Open
Abstract
Objectives: This study aimed to analyze the effect of a multimodal prehabilitation program for colorectal cancer patients in body composition, physical and cardiorespiratory fitness as well as its ability to reduce postoperative complications. Methods: A longitudinal observational study evaluated the efficacy of a prehabilitation intervention based on four components: (a) health education and self-care, (b) nutritional counseling, (c) psychological support, and (d) supervised physical exercise. Body composition was determined through bioelectrical impedance analysis; physical fitness variables such as strength was measured by a handgrip dynamometer for upper limbs, and a squat-jump test, countermovement jump test using a contact platform, and a chair-stand test for lower limbs. Flexibility was assessed with the sit-and-reach test. Cardiorespiratory fitness was assessed with the 6 min walking test (6MWT). Moreover, we measured lifestyles related to the amount of physical exercise by accelerometry. Results: The final cohort included 30 patients. Patients completed an average of 9.90 ± 5.26 exercise sessions. Statistically significant changes with varying effect sizes were observed in the following outcomes: SJ values in cm and W for both sexes (p = 0.021/d = 0.14 and p = 0.043/d = 0.10, respectively), SJ in W for women (p = 0.023/d = 0.21), all chair-stand test values (p = 0.021/d = 0.65 for men, p = 0.004/d = 2.08 for women, and p = 0.000/d = 0.84 for both sexes), and sit-and-reach for both sexes (p = 0.005/d = 0.12) and for men (p = 0.044/d = 0.08). All 6MWT values had statistically significant changes (p = 0.001/0.46). Women reduced the weekly minutes spent in sedentary behavior (p = 0.037/d = 0.65) and increased the minutes spent performing light physical activity (p = 0.037/d = 0.63). With regard to surgical outcomes, there was a tendency towards a decrease in postoperative complications and hospitalization days, as well as minutes in postoperative REA (p = 0.009/d = 0.69) in relation to the control group. Conclusions: Participation in a multimodal prehabilitation program improves several aspects of physical condition and lifestyles related to the amount of physical exercise and reduces both days of hospitalization and several complications post-surgery.
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Affiliation(s)
- María-Pilar Suárez-Alcázar
- Nursing Department, University of Jaime I, Av. Vicente Sos Baynat s/n, 12071 Castellón de la Plana, Castellón, Spain; (M.-P.S.-A.); (A.F.A.); (P.S.-M.); (E.J.C.-B.)
| | - Ana Folch Ayora
- Nursing Department, University of Jaime I, Av. Vicente Sos Baynat s/n, 12071 Castellón de la Plana, Castellón, Spain; (M.-P.S.-A.); (A.F.A.); (P.S.-M.); (E.J.C.-B.)
| | - María Muriach
- Medicine Department, University of Jaime I, Av. Vicente Sos Baynat s/n, 12071 Castellón de la Plana, Castellón, Spain;
| | - Paula Recacha-Ponce
- Nursing Department, University of Jaime I, Av. Vicente Sos Baynat s/n, 12071 Castellón de la Plana, Castellón, Spain; (M.-P.S.-A.); (A.F.A.); (P.S.-M.); (E.J.C.-B.)
| | - M.-Elena Garcia-Roca
- Department of Physical Activity and Oncology, University of Jaime I, Av. Vicente Sos Baynat s/n, 12071 Castellón de la Plana, Castellón, Spain;
| | - Alba Coret-Franco
- Hospital Universitario General de Castellón, Av. Benicàssim, 128, 12004 Castellón de la Plana, Castellón, Spain; (A.C.-F.); (J.C.P.-M.)
| | - Juan Carlos Pastor-Mora
- Hospital Universitario General de Castellón, Av. Benicàssim, 128, 12004 Castellón de la Plana, Castellón, Spain; (A.C.-F.); (J.C.P.-M.)
| | - Pablo Salas-Medina
- Nursing Department, University of Jaime I, Av. Vicente Sos Baynat s/n, 12071 Castellón de la Plana, Castellón, Spain; (M.-P.S.-A.); (A.F.A.); (P.S.-M.); (E.J.C.-B.)
| | - Eladio J. Collado-Boira
- Nursing Department, University of Jaime I, Av. Vicente Sos Baynat s/n, 12071 Castellón de la Plana, Castellón, Spain; (M.-P.S.-A.); (A.F.A.); (P.S.-M.); (E.J.C.-B.)
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Keshavjee S, Mckechnie T, Shi V, Abbas M, Huang E, Amin N, Hong D, Eskicioglu C. The Impact of Sarcopenia on Postoperative Outcomes in Colorectal Cancer Surgery: An Updated Systematic Review and Meta-Analysis. Am Surg 2025; 91:887-900. [PMID: 40127466 DOI: 10.1177/00031348251329748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2025]
Abstract
Sarcopenia is thought to be a marker for underlying frailty and malnutrition, contributing to poor functional status and suboptimal healing postoperatively. We aimed to complete an updated systematic review and meta-analysis evaluating the impact of sarcopenia on short- and long-term outcomes following colorectal cancer surgery. We searched MEDLINE, Embase, and CENTRAL up to September 2023. Studies that compared sarcopenic and non-sarcopenic patients' short- and long-term outcomes following curative intent elective surgery for colorectal cancer were included. The main outcomes included postoperative morbidity, postoperative mortality, and length of stay (LOS), among others. Inverse variance random effects meta-analyses was performed. Risk of bias was assessed with Cochrane tools. Certainty of evidence was assessed with GRADE. After screening 215 studies, we included 40 non-randomized studies, totalling 13,422 patients, of which 5,432 (40.4%) were classified as sarcopenic. Across 27 studies, patients with sarcopenia were more likely to experience 30-day postoperative morbidity (40% vs 33%, RR 1.30, 95% CI 1.12-1.50, P < 0.01, I2 79%). The mean LOS was 1.46 days longer for sarcopenic patients (26 studies, 95% CI 0.85-2.07, P < 0.01, I2 82%). Upon pooling data from 13 studies, sarcopenic patients had increased risk of 30-day postoperative mortality (2.8% vs 1.0%, RR 2.74, 95% CI 1.63-4.62, P < 0.01, I2 0%). The findings from this systematic review suggest with low to very-low certainty evidence that in patients who are undergoing curative intent surgery for colorectal cancer, preoperative sarcopenia is associated with poor postoperative outcomes.
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Affiliation(s)
- Sara Keshavjee
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Tyler Mckechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Victoria Shi
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Muhammad Abbas
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Elena Huang
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nalin Amin
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
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Groen LC, Timmers TG, Daams FD, Doodeman HJ, Schreurs HW, Bruns ER. Fit4Surgery app: Home-based prehabilitation app for older patients undergoing elective colorectal cancer surgery. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109691. [PMID: 40043662 DOI: 10.1016/j.ejso.2025.109691] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2024] [Revised: 12/29/2024] [Accepted: 02/10/2025] [Indexed: 05/13/2025]
Abstract
BACKGROUND Supervised multimodal prehabilitation prior to colorectal cancer (CRC) surgery is associated with reduced complications and enhanced recovery. However, it is labor intensive and expensive. In an aging population with increasing demand and costs on healthcare and staff shortages, home-based prehabilitation (HBP) with an app could be of interest. This study assessed the effectiveness of a Fit4Surgery app in CRC surgery. METHOD The app was effectuated in a prospective cohort study of 100 CRC patients ≥60 years from October 2021-December 2022. The primary outcome was preservation or improvement of the 6-minute walking test (6MWT) six weeks postoperative, compared to baseline. Secondary outcomes were 90-day complication and mortality rate, 90-day readmission, length of stay, 6MWT and Short Performance Physical Battery (SPPB) at different timepoints and total costs. RESULTS Three patients needed urgent surgery, remaining 97 patients (mean age 72) using the app for at least three weeks. The 6MWT was preserved in 74.7 % with a 12.1 m higher mean six weeks postoperative, compared to baseline (p = 0.194). A significant higher 6MWT was observed after prehabilitation and one year postoperative, compared to baseline (p=<0.001). The SPPB was significant higher at all timepoints. Overall 90-day complication rate was 25.8 %, readmission rate 6.3 % and mortality occurred in 2.1 %. Total costs were €518.50 per patient. CONCLUSION This is the first study of multimodal HBP by an app for CRC surgery patients with high compliance. Results show promising results regarding functional capacity and a low occurrence of complications, in line with multimodal supervised prehabilitation. This by reducing costs by half.
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Affiliation(s)
- Lennaert Cb Groen
- Department of Surgery, Northwest Clinics, Alkmaar, NL, the Netherlands.
| | - Thomas Gc Timmers
- Department of IQ Health, Radboud University Medical Center, Nijmegen, NL, the Netherlands; Department of Digital Care Research, Interactive Studios, 's-Hertogenbosch, NL, the Netherlands
| | - Freek D Daams
- Department of Surgery, Academic University Medical Center Location VU, Amsterdam, NL, the Netherlands
| | - Hieronymus J Doodeman
- Department of Clinical Epidemiology, Northwest Clinics, Alkmaar, NL, the Netherlands
| | | | - Emma Rj Bruns
- Department of Surgery, Spaarne Hospital, Haarlem, NL, the Netherlands
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11
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Gao S, He Y, Jiang L, Yang J. Multimodal prehabilitation program for patients undergoing elective surgery for colorectal cancer: a scoping review. Front Oncol 2025; 15:1532624. [PMID: 40386553 PMCID: PMC12082037 DOI: 10.3389/fonc.2025.1532624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 04/07/2025] [Indexed: 06/01/2025] Open
Abstract
Objectives Multimodal prehabilitation has been widely used in patients undergoing surgery for colorectal cancer and has improved clinical outcomes. The aim of this scoping review is to review the content and current state of clinical practice of multimodal prehabilitation programs. Methods A systematic literature review of multimodal prehabilitation studies in patients undergoing colorectal cancer surgery was conducted according to the PRISMA extension framework for scoping reviews. The literature was searched via the PubMed, Web of Science, SCOPUS, EMBASE and Cochrane Library databases. The results of the study included the components of multimodal prehabilitation (exercise, nutritional, and psychological interventions) and related evaluation indicators, duration, and compliance-related components. Results This review included 12 studies with 9 randomized controlled trials, 1 pilot intervention study, 1 cohort study, and 1 mock-target trial design. Specific protocols for multimodal rehabilitation training vary widely, ranging in duration from 2-8 weeks, and were implemented in healthcare facilities, the community, and at home. Adherence rates ranged from 50% to almost 100%. Common outcome indicators include the 6-minute walk test, comorbidities, length of hospitalization, health-related quality of life, and several anxiety assessment scales. Conclusion Current evidence suggests that multimodal preconditioning has a positive effect on the clinical prognosis of patients undergoing elective colorectal cancer surgery. However, owing to the heterogeneity of multimodal rehabilitation in terms of implementation protocols and evaluation metrics, many high-quality studies are still needed to explore the optimal model of multimodal rehabilitation and promote its standardization.
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Affiliation(s)
| | | | | | - Jie Yang
- Colorectal Cancer Center, West China Hospital, Sichuan University/West China School of
Nursing, Sichuan University, Chengdu, Sichuan, China
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12
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Yu X, Li L. Enhancing the clinical relevance of prehabilitation research in colorectal surgery. Colorectal Dis 2025; 27:e70099. [PMID: 40231329 DOI: 10.1111/codi.70099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2025] [Accepted: 03/27/2025] [Indexed: 04/16/2025]
Affiliation(s)
- Xiujie Yu
- Department of General Surgery, Nursing Department, The First People's Hospital of Wuyi County, Zhejiang, China
| | - Ling Li
- Department of General Surgery, Nursing Department, The First People's Hospital of Wuyi County, Zhejiang, China
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13
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D'Amico F, Dormio S, Veronesi G, Guarracino F, Donadello K, Cinnella G, Rosati R, Pecorelli N, Baldini G, Pieri M, Landoni G, Turi S. Home-based prehabilitation: a systematic review and meta-analysis of randomised trials. Br J Anaesth 2025; 134:1018-1028. [PMID: 39919985 PMCID: PMC11947603 DOI: 10.1016/j.bja.2025.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 12/30/2024] [Accepted: 01/01/2025] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND Prehabilitation aims to enhance preoperative functional capacity through exercise, nutrition, and psychological programs. Home-based prehabilitation represents an alternative to hospital prehabilitation, with the advantage of not utilising hospital resources. This review aims to evaluate adherence and clinical effectiveness of home-based prehabilitation. METHODS We searched PubMed, Cochrane, and Embase up to October 1, 2024 for randomised controlled trials comparing home-based prehabilitation with standard care. The primary outcome was the proportion of patients with postoperative complications. Secondary outcomes included protocol adherence, and 6-min walking test. We used risk ratios (RR) and mean differences to summarise the results. The risk of bias was assessed using RoB 2 tool. RESULTS We included 29 randomised trials for a total of 3508 patients. Median adherence to home-based prehabilitation programs was 82%. Home-based prehabilitation reduced the proportion of patients with postoperative complications (508/1322 [38.4%] vs 578/1335 [43.3%], risk ratio 0.84, 95% confidence interval [CI] 0.72-0.98, P=0.02, I2=44%, low certainty). After home-based prehabilitation, 6-min walking test performance was better compared with control (MD 28.2 m (95% CI 9.5-46.9; P<0.01, I2=48). Preoperative depression (MD -0.65, 95% CI -0.87 to -0.43; P<0.001, I2=0%), postoperative anxiety (MD -0.50, 95% CI -0.75 to -0.25; P<0.001, I2=0%, low certainty) and length of hospital stays (MD -0.32 days, 95% CI -0.61 to -0.03; P=0.03, I2=45%, low certainty) were lower with home-based prehabilitation. CONCLUSIONS Home-based prehabilitation reduced the proportion of patients with postoperative complications, but with low certainty of evidence. It also improved preoperative functional capacity, reduced hospital stays, depression and anxiety scores, with good adherence to the intervention. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42024591208).
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Affiliation(s)
- Filippo D'Amico
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Dormio
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Veronesi
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabio Guarracino
- Department of Cardiothoracic Anaesthesia and ICU, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Katia Donadello
- Department of Anaesthesia and Intensive Care B, Department of Surgery, Dentistry, Gynaecology and Pediatrics, University of Verona, AOUI-University Hospital Integrated Trust of Verona, Verona, Italy
| | - Gilda Cinnella
- Department of Anesthesia and Intensive Care, University Hospital of Foggia, Foggia, Italy
| | - Riccardo Rosati
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Pecorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Baldini
- Department of Health Science, University of Florence, Florence, Italy; Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Prehabilitation Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marina Pieri
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Giovanni Landoni
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Turi
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Gränicher P, Reicherzer L, Wanivenhaus F, Farshad M, Spörri J, Wirz M, Scherr J. Supervised prehabilitation in patients scheduled for spinal surgery - a scoping review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2025; 34:1366-1385. [PMID: 39920321 DOI: 10.1007/s00586-025-08710-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 01/06/2025] [Accepted: 01/30/2025] [Indexed: 02/09/2025]
Abstract
BACKGROUND CONTEXT Prehabilitation before spinal surgery may enhance patients' ability to withstand physical and mental stress during the perioperative period. It has the potential to reduce complications, accelerate recovery, and deliver sustainable, patient-relevant improvements. However, high-quality evidence remains limited, and it is unclear which prehabilitation concepts, training protocols, and outcomes are most effective for different patient groups. PURPOSE To evaluate the current state of research on preoperative interventions before spinal surgery, including the representation of subgroups, types of surgical procedures, and prehabilitation concepts. Additionally, it examines the outcomes analyzed and the methodologies employed in existing studies. STUDY DESIGN Scoping review based on a systematic literature search. METHODS A comprehensive database search in MEDLINE/PubMed, EMBASE (Ovid), CINAHL (EBSCO), Cochrane Library, Physiotherapy Evidence Database, Web of Science and Scopus was conducted. Exercise- and/or education-based prehabilitation concepts were identified, and findings were clustered and summarized according to PRISMA reporting standards. RESULTS Thirty-six reports from 23 studies (50% RCTs), evaluating prehabilitation programs in terms of feasibility, experiences, and effects on physical performance, self-reported function, pain, psychological outcomes and health-economic factors were included. These studies encompassed 2,964 participants scheduled for spinal surgery and reported a wide range of preoperative interventions, settings, and adherence rates. Prehabilitation focused primarily on education (87%) and exercise (35%), either independently or in combination. Most authors have concluded that preoperative interventions benefit patients awaiting spinal surgery, particularly by improving self-reported function, disability, and pain in both the short and long term. However, the findings also highlight the variability in outcomes, strengths, limitations, and recommendations across studies. Notably, 76% of the authors advocated for preoperative preparation, emphasizing the importance of structured, personalized programs and the need for further large-scale clinical trials. CONCLUSION Based on the current evidence, preparation for spinal surgery is recommended, provided that it is individualized, multimodal, and interdisciplinary, and addresses patients' specific impairments, resources, and expectations. Future research should focus on identifying subgroups defined by biopsychosocial risk factors that may influence short- and long-term perioperative outcomes.
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Affiliation(s)
- Pascale Gränicher
- Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Maastricht University, Peter Debyeplein 1, Maastricht, 6229 HA, The Netherlands.
- University Center for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 319, Zurich, CH-8008, Switzerland.
| | - Leah Reicherzer
- Institute of Physiotherapy, Research and Development, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, CH-8401, Switzerland
| | - Florian Wanivenhaus
- Department of Orthopedics, Balgrist University Hospital, University Spine Center Zurich, University of Zurich, Forchstrasse 340, Zurich, CH-8008, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University Spine Center Zurich, University of Zurich, Forchstrasse 340, Zurich, CH-8008, Switzerland
| | - Jörg Spörri
- University Center for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 319, Zurich, CH-8008, Switzerland
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Lengghalde 5, Zürich, CH-8008, Switzerland
| | - Markus Wirz
- Institute of Physiotherapy, Research and Development, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, CH-8401, Switzerland
| | - Johannes Scherr
- University Center for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 319, Zurich, CH-8008, Switzerland
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15
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Moyen A, Keane C, Chen Y, Tahasildar B, Lambert G, Drummond K, Carli F, Gillis C. Feasibility of a virtual multimodal prehabilitation intervention for patients with cancer undergoing surgery. Clin Nutr ESPEN 2025; 66:121-134. [PMID: 39828215 DOI: 10.1016/j.clnesp.2025.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 12/20/2024] [Accepted: 01/05/2025] [Indexed: 01/22/2025]
Abstract
BACKGROUND AND AIMS Current prehabilitation programs are often limited by poor recruitment and attrition rates. Remote delivery of prehabilitation may reduce barriers to participation and maximize program retention. We aimed to assess the feasibility (uptake, retention, fidelity), preliminary effectiveness, and acceptability of delivering a technology-supported prehabilitation program remotely to oncologic surgical candidates. METHODS This was a one-arm pragmatic feasibility study aiming to follow patients for 4-6 weeks preoperatively and 8 weeks postoperatively. All patients received a home-based aerobic and resistance exercise program, with psychosocial counselling as needed. Those at risk of malnutrition received nutritional counselling and supplements to meet personalized energy and protein targets. Adherence was assessed using an exercise watch and a mobile application for dietary assessment. In addition, we assessed physical effects, with change in 6-min walking distance of 20m defined as clinically meaningful recovery, and post-operative complications. Acceptability was assessed using a convergence mixed-methods approach. RESULTS A total of 28 participants were included (median 69, IQR 9.5 years; 12/28, 43 % males). Rate of recruitment was 47 %, retention was 78 %, and attendance was 86-93 %. Participants walked an average of 8168 (SD: 4685) steps per day preoperatively and 6809 (SD: 4819) steps per day postoperatively. They consumed on average 21.6 kcal/kg of ideal body weight (IBW) and 1.1 g protein/kg IBW during the first week of the intervention. Participants demonstrated significant improvements in remote physical tests before surgery (arm strength: +9.7 [5.7, 13.6] repetitions in arm curl, p < 0.001; leg strength: +3.2 [1.4, 4.9] sit-to-stand repetitions in 30 s, p = 0.001; endurance: +19.4 [12.7, 26.1] repetitions in the 2-min step test, p < 0.001). The majority (16/22, 73 %) achieved clinically meaningful recovery at 8 weeks postoperatively. All participants attested to the acceptability of exercising with remote supervision. CONCLUSION A technology-assisted prehabilitation program delivered remotely is feasible and could lead to physical benefits for a surgical cancer population.
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Affiliation(s)
- Audrey Moyen
- School of Human Nutrition, McGill University, 21111 Lakeshore Rd, Sainte-Anne-de-Bellevue, QC, H9X 3V9, Canada; Research Institute of the McGill University Health Centre, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Ciarán Keane
- Department of Physiotherapy, McGill University Health Centre, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada
| | - Yabo Chen
- School of Human Nutrition, McGill University, 21111 Lakeshore Rd, Sainte-Anne-de-Bellevue, QC, H9X 3V9, Canada
| | - Bhagya Tahasildar
- Department of Anesthesia, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Geneviève Lambert
- Department of Anesthesia, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Kenneth Drummond
- Department of Surgery, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, 21111 Lakeshore Rd, Sainte-Anne-de-Bellevue, QC, H9X 3V9, Canada; Department of Anesthesia, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada; Department of Surgery, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
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16
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Latini E, Parisi A, Cerulli C, Grazioli E, Tranchita E, Murri A, Mercantini P, Lucarini A, Gasparrini M, Ridola L, Tagliente L, Santoboni F, Trischitta D, Vetrano M, Visco V, Vulpiani MC, Nusca SM. Supervised Home-Based Exercise Intervention in Colorectal Cancer Patients Following Surgery: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:524. [PMID: 40283751 PMCID: PMC12027171 DOI: 10.3390/ijerph22040524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Revised: 03/21/2025] [Accepted: 03/25/2025] [Indexed: 04/29/2025]
Abstract
This pilot study aimed to assess the feasibility and preliminary effects of a supervised, home-based exercise program in patients recovering from laparoscopic colorectal cancer surgery. A total of 23 patients were included, with 13 participating in the exercise intervention and 10 receiving standard postoperative care. The exercise group (intervention group) followed a two-month structured program, while the control group received no structured exercise. Feasibility was demonstrated by 98% adherence in the intervention group and no reported adverse events. At T1, the intervention group showed significant improvements in role function, cognitive function, and reduced fatigue compared to the control group. At T2, a significant difference was observed in physical function. Functional capacity, assessed by the Six-Minute Walk Test, was significantly better in the intervention group at T1, T2, and T3, as was physical performance measured by the Short Physical Performance Battery (SPPB) at T1, T2, and T3. No significant differences were observed between the groups in anxiety, depression, sleep quality, or body composition parameters. This study highlights the feasibility of a supervised home-based exercise program in the early postoperative phase, demonstrating positive effects on Quality of Life, functional recovery, and fatigue in colorectal cancer patients.
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Affiliation(s)
- Eleonora Latini
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (L.T.); (F.S.); (D.T.); (M.V.); (M.C.V.); (S.M.N.)
| | - Attilio Parisi
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.); (A.M.)
| | - Claudia Cerulli
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.); (A.M.)
| | - Elisa Grazioli
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.); (A.M.)
| | - Eliana Tranchita
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.); (A.M.)
| | - Arianna Murri
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy; (A.P.); (C.C.); (E.G.); (E.T.); (A.M.)
| | - Paolo Mercantini
- Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital,“Sapienza” University of Rome, 00189 Rome, Italy; (P.M.); (A.L.)
| | - Alessio Lucarini
- Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital,“Sapienza” University of Rome, 00189 Rome, Italy; (P.M.); (A.L.)
| | - Marcello Gasparrini
- Department of General Surgery, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy;
| | - Lorenzo Ridola
- Department of Medical and Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Luca Tagliente
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (L.T.); (F.S.); (D.T.); (M.V.); (M.C.V.); (S.M.N.)
| | - Flavia Santoboni
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (L.T.); (F.S.); (D.T.); (M.V.); (M.C.V.); (S.M.N.)
| | - Donatella Trischitta
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (L.T.); (F.S.); (D.T.); (M.V.); (M.C.V.); (S.M.N.)
| | - Mario Vetrano
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (L.T.); (F.S.); (D.T.); (M.V.); (M.C.V.); (S.M.N.)
| | - Vincenzo Visco
- Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy;
| | - Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (L.T.); (F.S.); (D.T.); (M.V.); (M.C.V.); (S.M.N.)
| | - Sveva Maria Nusca
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, 00189 Rome, Italy; (L.T.); (F.S.); (D.T.); (M.V.); (M.C.V.); (S.M.N.)
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Cai R, Lin H, Mao Q, Zhang C, Tan Y, Cheng Q. Research hotspots and trends in cancer rehabilitation: a bibliometric analysis (2013-2023). Support Care Cancer 2025; 33:296. [PMID: 40100306 PMCID: PMC11919980 DOI: 10.1007/s00520-025-09355-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Accepted: 03/10/2025] [Indexed: 03/20/2025]
Abstract
BACKGROUND Advances in medical care have made cancer rehabilitation an essential component of comprehensive cancer treatment. However, bibliometric analyses in this field remain limited. This study maps the global research landscape of cancer rehabilitation over the past decade. METHODS Relevant publications on cancer rehabilitation from 2013 to 2023 were retrieved from the Web of Science Core Collection (WoSCC) database. Bibliometric analysis was conducted using VOSviewer, CiteSpace, and the R package "Bibliometrics." RESULTS A total of 6743 publications from 98 countries demonstrated sustained growth, peaking in 2022. The USA (1581 publications) and China (974) led in research output, while the Netherlands recorded the highest citation impact (32.75 citations per paper). Key institutions included the University of Texas MD Anderson Cancer Center (148 publications) and Memorial Sloan Kettering Cancer Center (40.58 citations per paper). Supportive Care in Cancer ranked as the most influential journal. Research efforts primarily focused on exercise interventions (n = 404), quality of life (n = 688), and breast cancer rehabilitation (n = 440). Recent trends highlighted telemedicine, digital health, and breast cancer-related lymphedema. CONCLUSION This analysis highlights the dominance of high-income countries in cancer rehabilitation research and identifies exercise, quality of life, and breast cancer as enduring focal points. Emerging priorities include technology-driven interventions and lymphedema management. However, critical gaps remain, such as the underrepresentation of low-resource regions, limited focus on pediatric populations, and insufficient integration of advanced technologies (e.g., AI, wearables). Future efforts should emphasize equitable resource distribution, evidence-based pediatric rehabilitation models, and scalable technology-driven solutions to address global disparities and improve survivorship care.
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Affiliation(s)
- Ruijuan Cai
- Guang'Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongsheng Lin
- Guang'Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
| | - Qiyuan Mao
- Guang'Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Chuchu Zhang
- Institute of Chinese Medicine Information, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ying Tan
- Guang'Anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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18
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Liao YS, Chiu HY, Huang FH, Chang YH, Huang YM, Wei PL, Wang W, Hung CS, Tung HH. Prehabilitation Interventions in Patients Undergoing Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis. J Am Geriatr Soc 2025. [PMID: 40079672 DOI: 10.1111/jgs.19425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 02/09/2025] [Accepted: 02/13/2025] [Indexed: 03/15/2025]
Abstract
BACKGROUND Surgical resection is the primary treatment modality for colorectal cancer. Prehabilitation is about enhancing the patient's physiological capacity preoperatively to reduce the risk of treatment-related complications. Clear definitions of the modality, content, and duration of prehabilitation, including its components such as nutrition, exercise, and psychological support, are lacking. Some review articles have proposed that a multimodal approach may yield the best overall outcomes, but the clinical efficacy of such an approach requires further exploration. OBJECTIVE This study consisted of a systematic review and meta-analysis to investigate the effectiveness of multimodal prehabilitation programs for patients undergoing colorectal surgery. METHODS We searched PubMed, Embase, CINAHL, and the Cochrane Library from inception to August 5, 2023, without language or publication period restrictions. The included studies were randomized controlled trials, prospective studies, or retrospective studies that examined the effectiveness of multimodal prehabilitation programs for patients undergoing colorectal surgery. A random-effects model was used for data analysis. RESULTS This study included 14 articles that analyzed data from 2314 patients who underwent colorectal cancer surgery. In comparisons against a control group, multimodal prehabilitation significantly reduced the length of hospital stay ([mean difference; MD] = -2.47 days, 95% confidence interval [CI] [-3.56, -1.39]), postoperative complication rate (odds ratio; [OR] = 0.74, 95% CI [0.59, 0.94]), and time to the first passage of flatus (MD = -0.43 days, 95% CI [-0.66, -0.20]). CONCLUSION Multimodal prehabilitation interventions before colorectal cancer surgery reduce hospital stay lengths, lower complication rates, and promote bowel recovery, particularly in older populations.
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Affiliation(s)
- Yi-Shu Liao
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsiao-Yean Chiu
- Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Fu-Huan Huang
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, Division of Pediatric Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yu-Han Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yu-Min Huang
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, Division of Gastrointestinal Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Po-Li Wei
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, Division of Colorectal Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Weu Wang
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, Division of Gastrointestinal Surgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chin-Sheng Hung
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Surgery, Division of Breast Surgery, Taipei Medical University Hospital, Taipei, Taiwan
| | - Heng-Hsin Tung
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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19
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Muchut LC, Bustos LF, Hidalgo ME, Vasile FE. Nutritional Prehabilitation: Trends in Supplementation Based on Sustainable Dairy Protein Sources. Curr Nutr Rep 2025; 14:31. [PMID: 39932655 DOI: 10.1007/s13668-025-00623-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2025] [Indexed: 05/08/2025]
Abstract
PURPOSE OF REVIEW Prehabilitation is an emerging clinical practice that aims to improve the surgical recovery and quality of life of patients undergoing intensive treatments. This review intends to describe the state of the art in prehabilitation, highlighting the role of nutritional strategies and the current trends in supplements. RECENT FINDINGS Up-to-date studies have shown the importance of optimizing the nutritional status of patients to cope with the physical and metabolic demands of surgery and intensive treatments. In the context of nutritional prehabilitation, oral nutritional supplementation has emerged as a preferred strategy. The effectiveness of prehabilitation has been demonstrated in various clinical contexts. However, the lack of standardized protocols makes it hard to compare the outcomes. Despite the variability in this type of nutritional intervention found in reports, it has been shown that the most common oral nutritional supplements (ONS) contain dairy proteins. The use of whey proteins represents a promising approach from both a nutritional and a sustainability perspective.
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Affiliation(s)
- Luciana Cecilia Muchut
- Universidad Nacional del Chaco Austral and CONICET - Instituto de investigaciones en procesos tecnológicos avanzados (INIPTA), Presidencia Roque Sáenz Pena, Comandante Fernández 755, Chaco, 3700, Argentina
| | - Leandro Fabián Bustos
- Universidad Nacional del Chaco Austral and CONICET - Instituto de investigaciones en procesos tecnológicos avanzados (INIPTA), Presidencia Roque Sáenz Pena, Comandante Fernández 755, Chaco, 3700, Argentina
| | - María Eugenia Hidalgo
- Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario (UNR) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Rosario, Santa Fe, 2000, Argentina
| | - Franco Emanuel Vasile
- Universidad Nacional del Chaco Austral and CONICET - Instituto de investigaciones en procesos tecnológicos avanzados (INIPTA), Presidencia Roque Sáenz Pena, Comandante Fernández 755, Chaco, 3700, Argentina.
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20
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Chmelova I, Pastucha D, Hudecek T, Guran Z, Ciecotkova S, Martínek L, Zubikova J, Matlova A, Dolezel J, Salounova D, Chmelo J. Prehabilitation during neoadjuvant therapy in patients with cancer of the upper gastrointestinal tract and rectum-the study protocol. Front Sports Act Living 2025; 6:1495398. [PMID: 39963182 PMCID: PMC11830712 DOI: 10.3389/fspor.2024.1495398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 12/31/2024] [Indexed: 02/20/2025] Open
Abstract
Aims The concept of prehabilitation, defined as interventions aimed at enhancing a patient's functional capacity prior to an impending physiological stressor, may contribute to reduced postoperative morbidity and mortality. The study's goal is to verify or refute the feasibility of a prehabilitation programme for two diagnostic patient groups during neoadjuvant chemo(radio)therapy, which is prescribed before the scheduled surgical procedure. This is a single group study design, with all patients enrolled receiving the intervention. Methods This is an interventional feasibility study of a prehabilitation programme in the form of physical training conducted at home. The training consists of progressively dosed walking and strength exercises for selected muscle groups. Data will be monitored telemetrically and also through telephone contact with participants. Primary outcomes include: the percentage of patients interested in participating in the study out of all patients indicated for neoadjuvant therapy at University Hospital Ostrava during the observed period, the percentage of patients who complete the prehabilitation programme until the date of surgery and individual patient compliance. Secondary outcomes include physical fitness parameters obtained from cardiopulmonary exercise testing, grip strength measured by a dynamometer, changes in body composition, EORTC QLQ-C30 quality of life questionnaire, and a questionnaire on the subjective perception of the exercise programme. Both primary and secondary outcomes will be compared between study arms (two diagnostic groups). The study is registered at ClinicalTrials.gov, ID: NCT05646043. Conclusion The results of this study can serve as a foundation for larger, multicentre, controlled studies in the future.
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Affiliation(s)
- Irina Chmelova
- Department of Rehabilitation and Sports Medicine, University Hospital Ostrava, Ostrava, Czechia
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Dalibor Pastucha
- Department of Rehabilitation and Sports Medicine, University Hospital Ostrava, Ostrava, Czechia
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Tomas Hudecek
- Department of Rehabilitation and Sports Medicine, University Hospital Ostrava, Ostrava, Czechia
| | - Zdenek Guran
- Department of Rehabilitation and Sports Medicine, University Hospital Ostrava, Ostrava, Czechia
- Department of Rehabilitation and Sports Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Sona Ciecotkova
- Department of Rehabilitation and Sports Medicine, University Hospital Ostrava, Ostrava, Czechia
| | - Lubomír Martínek
- Department of Surgery, University Hospital Ostrava, Ostrava, Czechia
| | - Jana Zubikova
- Department of Oncology, University Hospital Ostrava and Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Alena Matlova
- Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czechia
| | - Jakub Dolezel
- Centre for Telemedicine Services, University Hospital Ostrava, Ostrava, Czechia
| | - Dana Salounova
- Centre for Health Research, Faculty of Medicine, University of Ostrava, Ostrava, Czechia
| | - Jakub Chmelo
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
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Lee KY, Lee SY, Choi M, Kim M, Kim JH, Song JM, Yang SY, Yang IJ, Choi MS, Han SR, Han EC, Hong SH, Park DJ, Park SJ. The 2024 Korean Enhanced Recovery After Surgery (ERAS) guidelines for colorectal cancer: a secondary publication. Ann Coloproctol 2025; 41:3-26. [PMID: 40044109 PMCID: PMC11906033 DOI: 10.3393/ac.2024.00836.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 11/22/2024] [Indexed: 03/15/2025] Open
Abstract
The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition was established to develop ERAS guidelines tailored to the Korean context. This guideline focuses on creating the most current evidence-based practice guidelines for ERAS purposes, based on systematic reviews. All key questions targeted randomized controlled trials exclusively, and if fewer than 2 were available, studies employing propensity score matching were also included. Recommendations for each key question were marked with strength of recommendation and level of evidence following internal and external review processes by the committee.
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Affiliation(s)
- Kil-Yong Lee
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Miyoung Choi
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Moonjin Kim
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Ji Hong Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Myung Song
- Department of Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Seung Yoon Yang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - In Jun Yang
- Department of Surgery, Chungnam National University Hospital, Daejeon, Korea
| | - Moon Suk Choi
- Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | | | - Eon Chul Han
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Seoul National University Cancer Research Institute, Seoul, Korea
| | - Sang-Jae Park
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center Hospital, Goyang, Korea
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Moore J, Beaney A, Humphreys L, Merchant Z, Parmar KK, Levett D. Optimisation of the patient having oncological surgical through prehabilitation: a narrative review. Anaesthesia 2025; 80 Suppl 2:85-94. [PMID: 39775939 DOI: 10.1111/anae.16513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2024] [Indexed: 01/11/2025]
Abstract
INTRODUCTION Prehabilitation aims to improve physiological reserve and psychological resilience, enabling patients to better tolerate the physiological stress of major surgery, thereby reducing the risk of complications and improving surgical outcomes. In this review, we provide an update of the development of prehabilitation in patients having cancer surgery. METHODS We searched databases of peer-reviewed research to identify appropriate papers. Keywords comprised 'prehabilitation', 'cancer surgery' and associated synonyms (prehab; pre-operative rehabilitation; cancer). The results were combined with articles identified by reviewing the references of key papers and the use of the grey literature to develop our discussion. RESULTS We detail the different elements of prehabilitation (exercise, nutrition, psychological support) relevant to patients with cancer undergoing surgery, focusing on the recent evidence base and ongoing challenges. Within this, we consider the role of behaviour change in enabling patients to undertake prehabilitation interventions and reflect on the different models of prehabilitation that have been utilised. Facilitators and barriers to implementation of prehabilitation are explored. Key findings include positioning prehabilitation as an integral part of the oncological surgical pathway which includes, but is discrete from, medical optimisation. DISCUSSION Prehabilitation has the potential to improve surgical outcomes for patients undergoing cancer surgery. Further evidence is needed to understand how and what we provide to patients as optimal exercise, nutrition and psychological interventions as part of their surgical care, and how we improve long-term lifestyle using behaviour change methodology. Digital technology offers the opportunity for scaling and greater personalisation of prehabilitation but needs to be deliberately fashioned to ensure equitable access.
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Affiliation(s)
- John Moore
- Department of Anaesthesia, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- University of Manchester
| | - Alec Beaney
- Department of Anaesthesia, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Liam Humphreys
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Zoe Merchant
- North West Lung Centre, Manchester Foundation Hospital NHS Trust, Manchester, UK
| | - Krishna Kholia Parmar
- Department of Nutrition and Dietetics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Denny Levett
- Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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23
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Yeung S, Gill M, Gillis C. Nutrition education: Optimising preparation and recovery for benign oesophageal surgery. J Hum Nutr Diet 2025; 38:e13064. [PMID: 35821616 DOI: 10.1111/jhn.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients requiring upper gastrointestinal surgery for benign oesophageal conditions are at nutrition risk before and after surgery. There is a dearth of published evidence guiding clinicians on effective collaboration with patients to mitigate perioperative nutritional challenges. We conducted a qualitative study aiming to explore patients' perioperative food, nutrition, and educational experiences to guide future care. METHODS Adult patients who had undergone elective, benign oesophageal surgery were invited to participate in semi-structured interviews within 3 weeks of hospital discharge. Interviews were transcribed and analysed with a reflexive form of inductive thematic analysis in addition to synthesised member checking. RESULTS Interviews with 12 patients identified three major themes. First, nutrition education fosters a better surgical recovery experience: patients expressed a desire to be prepared for their upcoming surgery and engage in the recovery process with informed food choices. Most patients preferred preoperative education given limited capacity for learning during hospital admission. Second, patients have priorities for nutrition information: patients expressed that educational material should be printed, comprehensive, practical, include familiar foods and focus on managing postoperative physical symptoms. Third, food impacts social and emotional experiences of surgery: resumption of a normal diet was a sign of recovery that enabled social reintegration. Identified themes resonated with Knowles' six-core principles of andragogy. CONCLUSIONS Patients with benign oesophageal conditions perceived nutrition education to be a vital aspect of surgical preparation and recovery. Re-designing perioperative education with patient input has the potential to improve outcomes and experiences.
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Affiliation(s)
- Sophia Yeung
- Nutrition Services, Alberta Health Services, Calgary, AB, Canada
| | - Marlyn Gill
- Patient and Community Engagement Research, University of Calgary, Calgary, AB, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, QC, Canada
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Department of Surgery, McGill University, Montreal, QC, Canada
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24
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Carr ZJ, Siller S, McDowell BJ. Perioperative Pulmonary Complications in the Older Adults: The Forgotten System. Clin Geriatr Med 2025; 41:1-18. [PMID: 39551535 DOI: 10.1016/j.cger.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2024]
Abstract
With a rapidly aging population and increasing global surgical volumes, managing the elevated risk of perioperative pulmonary complications has become an expanding focus for quality improvement in health care. In this narrative review, we will analyze the evidence-based literature to provide high-quality and actionable management strategies to better detect, stratify risk, optimize, and manage perioperative pulmonary complications in geriatric populations.
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Affiliation(s)
- Zyad J Carr
- Department of Anesthesiology, Yale University School of Medicine, TMP-3, 333 Cedar Street, New Haven, CT 06520, USA.
| | - Saul Siller
- Department of Anesthesiology, Yale University School of Medicine, TMP-3, 333 Cedar Street, New Haven, CT 06520, USA
| | - Brittany J McDowell
- Department of Anesthesiology, Intermountain Medical Center, 5121 Cottonwood Street, Murray, UT 84107, USA
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Soh NH, Yau CRZ, Low XZ, Kadir HA, Fong WJ, Ramalingam MB, Tan PL, Ng KYY, Hsing YT, Cai M, Seo CJ, Ong JCA, Chia CS, Wong JSM. Prehabilitation Outcomes in Surgical Oncology Patients Undergoing Major Abdominal Surgery: A Meta-analysis of Randomized Control Trials. Ann Surg Oncol 2025; 32:1236-1247. [PMID: 39616295 DOI: 10.1245/s10434-024-16527-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 10/30/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND Prehabilitation has been increasingly utilized to optimize perioperative outcomes. In this study, we aim to evaluate the impact of uni- and multimodal prehabilitation on functional capacity and postoperative outcomes among surgical oncology patients undergoing major abdominal surgery. PATIENTS AND METHODS Three electronic databases (PubMed, Embase, Cochrane) were systematically searched up until December 2023. We included randomized controlled trials comparing prehabilitation to standard of care in surgical oncology patients undergoing major abdominal surgery. Our primary outcome was functional capacity as measured by the 6-min walk distance (6MWD). Secondary outcomes include postoperative complications, emergency readmissions, and length of stay (LOS). We stratified our findings to determine the impact of uni- versus multimodal prehabilitation on outcomes. RESULTS We included 27 studies with 2532 surgical oncology patients. Overall, patients undergoing prehabilitation demonstrated a significant improvement in preoperative functional capacity compared to those without prehabilitation (mean difference in 6MWD 28.32 meters [m], 95% CI 15.26, 41.39, p < 0.01). Prehabilitation was also associated with significantly lower odds of postoperative complications (odds ratio [OR] 0.60, 95% CI 0.46, 0.78, p < 0.01). There was no difference in emergency readmission (OR 0.90, 95% CI 0.59, 1.38, p = 0.61) or LOS (mean difference -0.42 days, 95% CI -1.01, 0.16, p = 0.15). Comparing uni- versus multimodal prehabilitation, multimodal prehabilitation was associated with greater improvements in functional capacity (6MWD 37.35 m versus 13.38 m) and lower odds of postoperative complications (OR 0.61, 95% CI 0.45, 0.82, p < 0.01 versus OR 0.63, 95% CI 0.36, 1.11, p = 0.10) CONCLUSION: Prehabilitation improves functional capacity and reduces postoperative complications among surgical oncology patients undergoing major abdominal surgery.
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Affiliation(s)
- Natalie Hann Soh
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
| | | | - Xi Zhi Low
- Duke-NUS Medical School, Singapore, Singapore
| | - Hanis Abdul Kadir
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
| | - Wei Jing Fong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
| | - Mothi Babu Ramalingam
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Pei Ling Tan
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Kennedy Yao Yi Ng
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Division of Population Health and Integrated Care, Singapore General Hospital, Singapore, Singapore
| | - Ya Ting Hsing
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Mingzhe Cai
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
| | - Chin Jin Seo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
| | - Johnny Chin-Ann Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore, Singapore
| | - Claramae S Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore.
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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Miralpeix E, Rodriguez-Cosmen C, Fabregó B, Sole-Sedeno JM, Carazo J, Sadurní M, Corcoy M, Mancebo G. Pre-operative impact of multimodal prehabilitation in gynecologic oncology patients. Int J Gynecol Cancer 2025; 35:100062. [PMID: 39971423 DOI: 10.1016/j.ijgc.2024.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Revised: 12/12/2024] [Accepted: 12/14/2024] [Indexed: 02/21/2025] Open
Abstract
OBJECTIVE Multimodal prehabilitation is a multi-disciplinary program that includes exercise, nutrition, and psychological intervention before surgery to improve pre-operative functional capacity. This study aims to assess the impact of a prehabilitation program on the pre-operative functional status of gynecologic oncology patients. METHODS This single-center, prospective observational study included all consecutive patients diagnosed with gynecologic cancer who were scheduled for surgery and enrolled in a structured prehabilitation program from January 2018 to May 2024. Only patients with both baseline and pre-operative evaluations were included. Functional status data were compared before (baseline) and after (pre-operative) the prehabilitation intervention. The primary outcome measured was functional capacity, as determined by the 6-minute walk test (6MWT). Secondary outcomes included hand grip strength, the Malnutrition Universal Screening Tool (MUST) score, and the Hospital Anxiety and Depression Scale score. The type of training and adherence were also evaluated. RESULTS A total of 77 patients underwent both baseline and pre-operative evaluation at the prehabilitation unit. The median duration of the program was 25.2 days (range; 9-63). Significant pre-operative improvements were observed in 6MWT (baseline: 435.7 m, standard deviation [SD] = 115.9 vs pre-operative: 455.7 m, SD = 118.9, p < .001), hand grip strength (baseline: 19.0 kg, SD = 5.5 vs pre-operative: 20.4 kg, SD = 5.9, p = .012), MUST score (baseline MUST ≥2 in 14.3% patients vs pre-operative 3.9%, p = .03), and Hospital Anxiety and Depression Scale score (baseline anxiety score: 7.4, SD = 4.3 vs pre-operative: 6.3, SD = 3.6, p < .001; and baseline depression score: 5.5, SD = 4.2 vs pre-operative: 4.3, SD = 3.6, p < .001). Among the different training programs, patients participating in supervised CrossFit training showed greater improvement in the 6MWT (33.4 m), compared to the hospital-supervised group (27.1 m), and the non-supervised home training group (14.0 m). CONCLUSIONS A structured multimodal prehabilitation program improves pre-operative functional capacity in gynecologic oncology patients, with the greatest improvements seen in those who participated in supervised high-intensity training, such as CrossFit.
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Affiliation(s)
- Ester Miralpeix
- Hospital del Mar, Department of Obstetrics and Gynecology, Barcelona, Spain; Pompeu Fabra University, Faculty of Medicine and Life Science, Barcelona, Spain.
| | | | - Berta Fabregó
- Hospital del Mar, Department of Obstetrics and Gynecology, Barcelona, Spain
| | - Josep-Maria Sole-Sedeno
- Hospital del Mar, Department of Obstetrics and Gynecology, Barcelona, Spain; Pompeu Fabra University, Faculty of Medicine and Life Science, Barcelona, Spain
| | - Jesus Carazo
- Hospital del Mar, Department of Anesthesiology, Resuscitation and Pain Relief, Barcelona, Spain
| | - Marc Sadurní
- Hospital del Mar, Department of Anesthesiology, Resuscitation and Pain Relief, Barcelona, Spain
| | - Marta Corcoy
- Hospital del Mar, Department of Anesthesiology, Resuscitation and Pain Relief, Barcelona, Spain
| | - Gemma Mancebo
- Hospital del Mar, Department of Obstetrics and Gynecology, Barcelona, Spain; Pompeu Fabra University, Faculty of Medicine and Life Science, Barcelona, Spain
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Jetten EEJ, Franssen RFW, Voorn MJJ, Falz R, Busse M, Bongers BC, Janssen‐Heijnen MLG, Hoogeboom TJ. Evaluating the therapeutic quality of prehabilitation programmes in patients scheduled for colorectal surgery: A systematic review and meta-analysis. Colorectal Dis 2025; 27:e70023. [PMID: 39934951 PMCID: PMC11814359 DOI: 10.1111/codi.70023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 12/10/2024] [Accepted: 01/20/2025] [Indexed: 02/13/2025]
Abstract
AIM The aim of this work was to evaluate whether the therapeutic quality of exercise prehabilitation programmes is associated with their effectiveness to preoperatively improve aerobic fitness and reduce postoperative complications and length of hospital stay in patients scheduled for colorectal surgery. METHOD Three electronic databases (PubMed, Embase and CINAHL) were systematically searched (up to October 2023) for randomized controlled trials that investigated the effects of prehabilitation before colorectal resection. Methodological quality and therapeutic quality were assessed using, respectively, the Cochrane Risk of Bias 2 tool and the i-CONTENT tool. Studies were divided into four subgroups based on the estimated risk of bias and risk of ineffectiveness. RESULTS Fourteen studies were included, comprising 986 patients. Meta-analysis showed that, in general, prehabilitation improved preoperative aerobic fitness but did not improve postoperative outcomes. No differences were found between the four subgroups; however, only one study (7%) had a low risk of bias in combination with a low risk of ineffectiveness. CONCLUSION The fact that only one study had a low risk of bias in combination with a low risk of ineffectiveness precluded us from establishing an association between therapeutic quality and the effectiveness of prehabilitation on postoperative outcomes. The quality of future prehabilitation research with exercise interventions should be improved by using an assessment tool during the design phase of prehabilitation programmes.
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Affiliation(s)
- Evy E. J. Jetten
- Department of Orthopaedic SurgeryVieCuri Medical CentreVenloThe Netherlands
- Department of Clinical EpidemiologyVieCuri Medical CentreVenloThe Netherlands
| | - Ruud F. W. Franssen
- Department of Clinical Physical TherapyVieCuri Medical CentreVenloThe Netherlands
| | - Melissa J. J. Voorn
- Department of Rehabilitation Medicine, Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Adelante Rehabilitation CentreVenloThe Netherlands
| | - Roberto Falz
- Institute of Sport Medicine and PreventionUniversity LeipzigLeipzigGermany
| | - Martin Busse
- Institute of Sport Medicine and PreventionUniversity LeipzigLeipzigGermany
| | - Bart C. Bongers
- Department of Nutrition and Movement Sciences, Institute of Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht UniversityMaastrichtThe Netherlands
- Department of Surgery, Institute of Nutrition and Translational Research in Metabolism (NUTRIM)Maastricht UniversityMaastrichtThe Netherlands
| | - Maryska L. G. Janssen‐Heijnen
- Department of Clinical EpidemiologyVieCuri Medical CentreVenloThe Netherlands
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
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Xu S, Yin R, Zhu H, Gong Y, Zhu J, Li C, Xu Q. The role of exercise-based prehabilitation in enhancing surgical outcomes for patients with digestive system cancers: a meta-analysis. BMC Gastroenterol 2025; 25:26. [PMID: 39844027 PMCID: PMC11753026 DOI: 10.1186/s12876-025-03626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 01/16/2025] [Indexed: 01/24/2025] Open
Abstract
BACKGROUND Prehabilitation is a crucial component of tumor rehabilitation that attempts to improve patients' preoperative health, although its efficacy in treating patients with cancers of the digestive system is still up for debate. METHODS The records from PubMed (MEDLINE), Embase, Web of Science, Cochrane Library, EBSCO, Scopus, CNKI and Wan fang database up to November 2024 were systematically searched. The Cochrane Collaboration tool was employed for evaluating the risk of bias in each study, and the PRISMA 2020 checklist provided by the EQUATOR network was utilized. RESULTS Through quality analysis, 20 articles were included, involving 1719 patients. Although its effect on severe complications is still unknown, the prehabilitation significantly decreased overall postoperative complications when compared to standard care, with a risk ratio (RR) of 0.74 (95% CI: 0.65 to 0.84). Despite not shortening the postoperative hospital stay (MD: -0.13, 95% CI: -0.29 to 0.03), prehabilitation demonstrated notable improvements in the 6-minute walk distance (6MWD), with preoperative gains (MD: 25.87, 95% CI: 14.49 to 37.25) and sustained benefits at 4 weeks postoperatively (MD: 22.48, 95% CI: 7.85 to 37.12). However, no significant differences in 6MWD were observed at 6 or 8 weeks postoperatively. The average improvement in 6MWD from baseline to preoperative was 28.99 (95% CI: 10.89 to 47.08, P = 0.002), and from 4 weeks postoperative to baseline, it was 25.95 (95% CI: 6.84 to 45.07, P = 0.008), with no significant change at 8 weeks. The acceptance and completion rates of prehabilitation were commendably high at 61% (95% CI: 47-75%) and 90% (95% CI: 87-93%), respectively, alongside a relatively low dropout rate of 10% (95% CI: 7% to13%). CONCLUSIONS Prehabilitation reduces postoperative complications and improves short-term physical function in digestive surgery patients, with good patient acceptance; however, the long-term effects are unknown due to a lack of follow-up data. REGISTRATION It was registered with the International Prospective Register of Systematic Reviews (PROSPERO) with the identification code CRD42022361100.
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Affiliation(s)
- Shasha Xu
- Department of Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, 210000, Jiangsu Province, China
| | - Rong Yin
- Department of Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, 210000, Jiangsu Province, China
| | - Haiou Zhu
- Department of Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, 210000, Jiangsu Province, China
| | - Yin Gong
- Department of Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, 210000, Jiangsu Province, China
| | - Jing Zhu
- Department of Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, 210000, Jiangsu Province, China
| | - Changxian Li
- Department of Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, 210000, Jiangsu Province, China
| | - Qin Xu
- Department of Nursing School, Nanjing Medical University, Nanjing, 210000, Jiangsu Province, China.
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Legault EP, Ribeiro PAB, Moreau-Amaru D, Robert E, Forte S, Comtois AS, Samouëlian V, Tournoux F. The PREPARE Study: Acceptability and Feasibility of a Telehealth Trimodal Prehabilitation Program for Women with Endometrial Neoplasia. Curr Oncol 2025; 32:55. [PMID: 39851971 PMCID: PMC11763516 DOI: 10.3390/curroncol32010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 01/11/2025] [Accepted: 01/13/2025] [Indexed: 01/26/2025] Open
Abstract
Patients with endometrial neoplasia (EN) often have multiple comorbidities and a higher surgical risk. Prehabilitation programs (PPs) combine various interventions to improve preoperative conditions and reduce impairment due to surgical stress. We conducted a pragmatic pilot study to evaluate the acceptability and feasibility of a trimodal telehealth PP (exercise, nutrition, and psychological support) for EN patients. The participants could select their exercise group: (1) a supervised PP (SPP), group sessions 3×/week; (2) a semi-supervised PP (SSPP), group session 1×/week, training alone 2×/week; or (3) a physical activity counseling session (PACS). Out of the 150 EN patients awaiting surgery screened during the 18 months of the study recruitment, 66% (99/150) were eligible, and 40% consented to participate (SPP, n = 13; SSPP, n = 17; PACS, n = 9). The overall dropout was low (13%; 5/39), with no significant differences across groups. No serious adverse events occurred. We observed a positive impact on different outcomes across the different groups, such as in the Functional Assessment of Cancer Therapy quality of life score (SPP; delta = 6.1 [CI: 0.9; 12.6]) and functional capacity measured using the 30″ sit-to-stand test (PACS delta = 2.4 [CI: 1.2; 3.6]). The same-day hospital leave was high in the SSPP group (54.5%). Our pilot telehealth PP seems to be safe, feasible, and well accepted and may procure clinical and patient-centered gains that need to be confirmed in a larger trial.
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Affiliation(s)
- Elise P. Legault
- Coeurlab Research Unit, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada; (P.A.B.R.); (F.T.)
- Département des Sciences de l’Activité Physique, Université du Québec à Montréal, Montréal, QC H2L 1Y4, Canada;
| | - Paula A. B. Ribeiro
- Coeurlab Research Unit, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada; (P.A.B.R.); (F.T.)
| | - Danielle Moreau-Amaru
- Service de Gynécologie Oncologique du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada; (D.M.-A.); (E.R.); (V.S.)
| | - Emmanuelle Robert
- Service de Gynécologie Oncologique du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada; (D.M.-A.); (E.R.); (V.S.)
| | - Sara Forte
- Service de Gynécologie Oncologique du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada; (D.M.-A.); (E.R.); (V.S.)
| | - Alain S. Comtois
- Département des Sciences de l’Activité Physique, Université du Québec à Montréal, Montréal, QC H2L 1Y4, Canada;
| | - Vanessa Samouëlian
- Service de Gynécologie Oncologique du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada; (D.M.-A.); (E.R.); (V.S.)
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), Montréal, QC H2X 0A9, Canada
- Département d’Obstétrique-Gynécologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
| | - François Tournoux
- Coeurlab Research Unit, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada; (P.A.B.R.); (F.T.)
- Service de Cardiologie du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0C1, Canada
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Damasceno AM, Kesley R, Valadão M, Braga F, D'Almeida CA, Pitombo MB. Preoperative management in octogenarian patients with rectal cancer. Heliyon 2025; 11:e41469. [PMID: 39834413 PMCID: PMC11742831 DOI: 10.1016/j.heliyon.2024.e41469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 12/09/2024] [Accepted: 12/23/2024] [Indexed: 01/22/2025] Open
Abstract
Background In recent years, the rise in average lifespan has been linked to an increase in the occurrence of diseases associated with aging worldwide. Rectal tumors often occur in elderly patients. Methods Between January and August 2024, 6 experts in colorectal cancer met to develop an algorithm to organize the interdisciplinary and multimodal preoperative approaches in the octogenarian population with rectal cancer. To develop the algorithm, we conducted a straightforward search within the PubMed database and also reviewed the citations of the most pertinent articles we discovered. The quality of the methods used in the final selection of 76 sources was evaluated, every single source was scrutinized and analyzed, and a team of six experts created an algorithm. Results An algorithm for preoperative management of octogenarian patients with rectal cancer was created to encapsulate essential information and provide a contemporary resource for physicians, surgeons, physiotherapists, and nutritionists to utilize in optimal clinical practice. Conclusions Octogenarian patients with rectal cancer are special-character groups and require specific preoperative management to better the surgical outcome.
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Affiliation(s)
- Arthur M. Damasceno
- Post-Graduate Program in Medical Sciences, Rio de Janeiro State University (UERJ), 444 Prof Manuel de Abreu Avenue, Rio de Janeiro, RJ, 20550-170, Brazil
| | - Rubens Kesley
- Abdominal Surgery Department and Nutritional and Dietetic Service, Brazil National Cancer Institute (INCA), 23 Praça da Cruz Vermelha, Rio de Janeiro, RJ, 20230-130, Brazil
| | - Marcus Valadão
- Abdominal Surgery Department and Nutritional and Dietetic Service, Brazil National Cancer Institute (INCA), 23 Praça da Cruz Vermelha, Rio de Janeiro, RJ, 20230-130, Brazil
| | - Fabrício Braga
- Laboratório de Performance Humana, 1 Largo do Ibam, Rio de Janeiro, RJ, 22271-070, Brazil
| | - Cristiane A. D'Almeida
- Abdominal Surgery Department and Nutritional and Dietetic Service, Brazil National Cancer Institute (INCA), 23 Praça da Cruz Vermelha, Rio de Janeiro, RJ, 20230-130, Brazil
| | - Marcos B. Pitombo
- Post-Graduate Program in Medical Sciences, Rio de Janeiro State University (UERJ), 444 Prof Manuel de Abreu Avenue, Rio de Janeiro, RJ, 20550-170, Brazil
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Diao YK, Li D, Wu H, Yang YF, Wang NY, Gu WM, Chen TH, Li J, Wang H, Zhou YH, Liang YJ, Wang XM, Lin KY, Gu LH, Xu JH, Pawlik TM, Lau WY, Shen F, Yang T. Association of preoperative frailty with short- and long-term outcomes after hepatic resection for elderly patients with hepatocellular carcinoma: multicentre analysis. BJS Open 2024; 9:zrae171. [PMID: 39921532 PMCID: PMC11806262 DOI: 10.1093/bjsopen/zrae171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 11/19/2024] [Accepted: 12/23/2024] [Indexed: 02/10/2025] Open
Abstract
BACKGROUND The growing demand for surgical resection in elderly patients with hepatocellular carcinoma highlights the need to understand the impact of preoperative frailty on surgical outcomes. The aim of this multicentre cohort study was to investigate the association between frailty and short- and long-term outcomes after hepatic resection among elderly patients with hepatocellular carcinoma. METHODS A multicentre analysis was conducted on elderly patients with hepatocellular carcinoma (aged greater than or equal to 70 years) who underwent curative-intent resection at ten Chinese hospitals from 2012 to 2021. Frailty was assessed using the Clinical Frailty Scale (with frailty defined as a Clinical Frailty Scale score greater than or equal to 5). The primary outcomes were overall survival and recurrence-free survival; secondary outcomes encompassed postoperative 30-day morbidity and mortality, and 90-day mortality. The outcomes between patients with and without preoperative frailty were compared. RESULTS Of the 488 elderly patients, 148 (30.3%) were considered frail. Frail patients experienced significantly higher 30-day morbidity (68.9% (102 of 148) versus 43.2% (147 of 340)), 30-day mortality (4.1% (6 of 148) versus 0.6% (2 of 340)), and 90-day mortality (6.1% (9 of 148) versus 0.9% (3 of 340)) compared with non-frail patients (all P < 0.010). During a median follow-up of 37.7 (interquartile range 20.4-57.8) months, frail patients demonstrated significantly worse median overall survival (41.6 (95% c.i. 32.0 to 51.2) versus 69.7 (95% c.i. 55.6 to 83.8) months) and recurrence-free survival (27.6 (95% c.i. 23.1 to 32.1) versus 42.7 (95% c.i. 34.6 to 50.8) months) compared with non-frail patients (both P < 0.010). Multivariable Cox regression analysis revealed frailty as an independent risk factor for decreased overall survival (HR 1.61; P = 0.001) and decreased recurrence-free survival (HR 1.32; P = 0.028). CONCLUSION Frailty is significantly associated with adverse short-term and long-term outcomes after resection in elderly patients with hepatocellular carcinoma. The findings suggest that frailty assessment should be incorporated into perioperative and postoperative evaluation for elderly patients undergoing hepatocellular carcinoma resection.
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Affiliation(s)
- Yong-Kang Diao
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Dan Li
- Department of Hepatobiliary and Pancreatic Surgery, General Surgery Centre, First Hospital of Jilin University, Changchun, Jilin, China
- Cancer Centre, First Hospital of Jilin University, Changchun, Jilin, China
| | - Han Wu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Yi-Fan Yang
- Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Nan-Ya Wang
- Phase I Clinical Trial Unit, Department of Clinical Research, First Hospital of Jilin University, Changchun, Jilin, China
| | - Wei-Min Gu
- First Department of General Surgery, Fourth Hospital of Harbin, Harbin, Heilongjiang, China
| | - Ting-Hao Chen
- Department of General Surgery, Ziyang First People’s Hospital, Ziyang, Sichuan, China
| | - Jie Li
- Department of Hepatobiliary Surgery, Fuyang People’s Hospital, Fuyang, Anhui, China
| | - Hong Wang
- Department of General Surgery, Liuyang People’s Hospital, Liuyang, Hunan, China
| | - Ya-Hao Zhou
- Department of Hepatobiliary Surgery, Pu’er People’s Hospital, Pu’er, Yunnan, China
| | - Ying-Jian Liang
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xian-Ming Wang
- Department of General Surgery, First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, Shandong, China
| | - Kong-Ying Lin
- Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fuzhou, Fujian, China
| | - Li-Hui Gu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Jia-Hao Xu
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Timothy M Pawlik
- Department of Surgery, Ohio State University, Wexner Medical Centre, Columbus, Ohio, USA
| | - Wan-Yee Lau
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
- Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Feng Shen
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
- Eastern Hepatobiliary Clinical Research Institute (EHCRI), Third Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Tian Yang
- Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
- Eastern Hepatobiliary Clinical Research Institute (EHCRI), Third Affiliated Hospital of Naval Medical University, Shanghai, China
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Sier MAT, Cox MPPJ, Tweed TTTT, Servaas N, Greve JWM, Stoot JHMB. Participation and Compliance in a Multimodal Prehabilitation Program for Colorectal Cancer (PACE): A Qualitative Study. Patient Prefer Adherence 2024; 18:2709-2720. [PMID: 39759885 PMCID: PMC11697675 DOI: 10.2147/ppa.s481567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 11/11/2024] [Indexed: 01/07/2025] Open
Abstract
Purpose Interest in prehabilitation, the preoperative enhancement of patients' condition, is rising in the surgical field. Challenging factors appear to be patients' motivation to participate in and their compliance with prehabilitation programs. The aim of this qualitative study was to study the real-life experience of prehabilitation by assessing the lived experience and perceptions of participants in a multimodal prehabilitation program and to explore factors that influence participation and compliance during prehabilitation. Methods Patients who underwent surgery for colorectal cancer and who had participated in the 4-week multimodal prehabilitation program "BEFORE" feasibility study were recruited. Their lived experiences were collected through semi-structured, individual, in-depth interviews. Interviews were transcribed verbatim and analyzed using a thematical approach. As no new information emerged after the interviews, data were considered saturated. Results Six patients were interviewed. Seven main themes were discussed during the interviews, including information provision, motivation for participation, and content of the program. The results of this study emphasize the importance of adequate patient education, in-hospital exercise with the supervision of physiotherapists, and a patient-centered program. Logistical problems and the impact of cancer diagnosis were most frequently reported as barriers to participation. Conclusion Participation could be improved by providing adequate information and solving logistical issues. Patient-centeredness of the program is an important feature in improving adherence.
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Affiliation(s)
- Misha A T Sier
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Maud P P J Cox
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6211 LK, The Netherlands
| | - Thaís T T T Tweed
- Department of Surgery, Maastricht University Medical Center+, Maastricht, 6229 hX, The Netherlands
| | - Nick Servaas
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6211 LK, The Netherlands
| | - Jan Willem M Greve
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6211 LK, The Netherlands
| | - Jan H M B Stoot
- Department of Surgery, Zuyderland Medical Center, Heerlen, 6419 PC, The Netherlands
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Machado P, Paixão A, Oliveiros B, Martins RA, Cruz J. Effect of home-based exercise prehabilitation on postoperative outcomes in colorectal cancer surgery: a systematic review and meta-analysis. Support Care Cancer 2024; 33:20. [PMID: 39663237 PMCID: PMC11635004 DOI: 10.1007/s00520-024-09069-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 12/02/2024] [Indexed: 12/13/2024]
Abstract
PURPOSE Home-based exercise training may improve access to surgical prehabilitation in colorectal cancer (CRC) patients, but its efficacy remains unclear. This study systematically investigated the effects of home-based exercise prehabilitation on postoperative exercise capacity, complications, length of hospital stay, and health-related quality of life (HRQoL) in CRC patients. METHODS Randomized controlled trials (RCTs) comparing home-based exercise prehabilitation with control in CRC patients were eligible. We searched MEDLINE, Scopus, Web of Science, PEDro, and SPORTDiscus from their inception to June 3, 2024. Methodological quality was assessed using the PEDro scale, and certainty of evidence was assessed using GRADE. Data were synthesized using random-effects meta-analyses, with sensitivity analysis on studies with good methodological quality (PEDro score ≥ 6). RESULTS Eight RCTs involving 1092 participants were included. The primary analysis showed a significant improvement in postoperative 6-min walk distance following home-based exercise prehabilitation compared to control (mean difference (MD) = 30.62: 95% CI: [2.94; 57.79]; low-certainty evidence). However, sensitivity analysis revealed no significant between-group differences (MD = 22.60: 95% CI: [- 6.27; 51.46]). No significant effects of home-based exercise prehabilitation were found on postoperative complications (risk ratio = 1.00: 95% CI: [- 0.78; 1.29]; moderate-certainty evidence), length of hospital stay (MD = - 0.20: 95% CI: [- 0.65; 0.23]; moderate-certainty evidence), and HRQoL (physical functioning: MD = 2.62: 95% CI: [- 6.16; 11.39]; mental functioning: MD = 1.35: 95% CI: [- 6.95; 9.65]; low and very-low certainty evidence). CONCLUSION Home-based exercise prehabilitation does not reduce postoperative complications and length of hospital stay after CRC surgery. Its effects on postoperative exercise capacity and HRQoL remain uncertain due to low-quality evidence.
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Affiliation(s)
- Pedro Machado
- School of Health Sciences of the Polytechnic of Leiria (ESSLei), Center for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal.
- Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal.
- Physical Therapy Clinics, Physioclem, Alcobaça, Portugal.
| | - André Paixão
- Sport Sciences School of Rio Maior (ESDRM), Santarém Polytechnic University, Santarém, Portugal
| | - Bárbara Oliveiros
- Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
| | - Raul A Martins
- Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Joana Cruz
- School of Health Sciences of the Polytechnic of Leiria (ESSLei), Center for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal
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Voss ML, Brick R, Padgett LS, Wechsler S, Joshi Y, Ammendolia Tomé G, Arbid S, Campbell G, Campbell KL, El Hassanieh D, Klein C, Lam A, Lyons KD, Sabir A, Sleight AG, Jones JM. Behavior change theory and behavior change technique use in cancer rehabilitation interventions: a secondary analysis. Eur J Phys Rehabil Med 2024; 60:1036-1050. [PMID: 39445735 PMCID: PMC11713631 DOI: 10.23736/s1973-9087.24.08452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/04/2024] [Accepted: 09/10/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND There is limited evidence depicting ways that behavioral theory and techniques have been incorporated into cancer rehabilitation interventions. Examining their use within cancer rehabilitation interventions may provide insight into the active ingredients that can maximize patient engagement and intervention effectiveness. AIM This secondary analysis aimed to describe the use of behavior change theory and behavior change techniques (BCTs) in two previously conducted systematic reviews of cancer rehabilitation interventions. DESIGN Secondary analysis of randomized controlled trials (RCTs) drawn from two systematic reviews examining the effect of cancer rehabilitation interventions on function and disability. SETTING In-person and remotely delivered rehabilitation interventions. POPULATION Adult cancer survivors. METHODS Data extraction included: behavior change theory use, functional outcome data, and BCTs using the Behavior Change Technique Taxonomy (BCTTv1). Based on their effects on function, interventions were categorized as "very", "quite" or "non-promising". To assess the relative effectiveness of coded BCTs, a BCT promise ratio was calculated (the ratio of promising to non-promising interventions that included the BCT). RESULTS Of 180 eligible RCTs, 25 (14%) reported using a behavior change theory. Fifty-four (58%) of the 93 BCTs were used in least one intervention (range 0-29). Interventions reporting theory use utilized more BCTs (median=7) compared to those with no theory (median=3.5; U=2827.00, P=0.001). The number of BCTs did not differ between the very, quite, and non-promising intervention groups (H(2)=0.24, P=0.85). 20 BCTs were considered promising (promise ratio >2) with goal setting, graded tasks, and social support (unspecified) having the highest promise ratios. CONCLUSIONS While there was a wide range of BCTs utilized, they were rarely based on theoretically-proposed pathways and the number of BCTs reported was not related to intervention effectiveness. CLINICAL REHABILITATION IMPACT Clinicians should consider basing new interventions upon a relevant behavior change theory. Intentionally incorporating the BCTs of goal setting, graded tasks, and social support may improve intervention efficacy.
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Affiliation(s)
- M Lauren Voss
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada
| | - Rachelle Brick
- Division of Cancer Control and Population Sciences, National Cancer Institute, Behavioral Research Program, Basic Biobehavioral and Psychological Sciences Research Branch, Rockville, MD, USA
| | - Lynne S Padgett
- Veterans Affairs, Office of Research Development, Washington DC, USA
| | - Stephen Wechsler
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Yash Joshi
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada
| | - Genevieve Ammendolia Tomé
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada
| | - Sasha Arbid
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada
| | - Grace Campbell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Duquesne University, School of Nursing, University of Pittsburgh School of Medicine, Pittsburgh, MA, USA
| | - Kristin L Campbell
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Dima El Hassanieh
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada
| | - Caroline Klein
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Adrienne Lam
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada
| | - Kathleen D Lyons
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Aisha Sabir
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Alix G Sleight
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jennifer M Jones
- University Health Network, Princess Margaret Cancer Center, Cancer Rehabilitation and Survivorship Program, Toronto, ON, Canada -
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Shahzad MH, Spicer JD, Rusch VW, Kneuertz PJ. Perioperative Immunotherapy for Node-Negative Non-Small Cell Lung Cancer-Current Evidence and Future Directions. Ann Thorac Surg 2024; 118:1177-1186. [PMID: 38621650 DOI: 10.1016/j.athoracsur.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/22/2024] [Accepted: 03/26/2024] [Indexed: 04/17/2024]
Abstract
Neoadjuvant immunotherapy has gone from an idea to an indication in locally advanced lung cancer. Several phase III trials have demonstrated the superiority of neoadjuvant chemoimmunotherapy compared with chemotherapy in this setting. Although such progress has revolutionized the treatment of locally advanced disease, the unmet needs of stage I and stage II patients without lymph node disease have largely been underrepresented in existing trials. Up-front resection with few patients going on to complete adjuvant therapy remains the norm for most stage I and II patients. Emerging evidence now supports the exploration of supplemental checkpoint blockade in well-selected early-stage, node-negative patients with large tumors and no actionable driver mutations. Although concerns surrounding safety and risk exist, patient selection could be substantially improved using novel biomarker approaches that leverage our understanding of the tumor immune microenvironment of lung cancer. This review provides a comprehensive overview of the opportunities and controversies of perioperative immunotherapy in node-negative lung cancer.
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Affiliation(s)
- Muhammad H Shahzad
- Division of Thoracic Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada; Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jonathan D Spicer
- Division of Thoracic Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada; Cancer Research Program, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peter J Kneuertz
- Division of Thoracic Surgery, Department of Surgery, The Ohio State Wexner Medical Center, Columbus, Ohio.
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Pesce A, Fabbri N, Colombari S, Uccellatori L, Grazzi G, Lordi R, Anania G, Feo CV. A randomized controlled clinical trial on multimodal prehabilitation in colorectal cancer patients to improve functional capacity: preliminary results. Surg Endosc 2024; 38:7440-7450. [PMID: 39210058 PMCID: PMC11614948 DOI: 10.1007/s00464-024-11198-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 08/17/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Major colorectal surgery is associated with 20 to 40% reduction in physiological and functional capacity and higher level of fatigue 6 to 8 weeks after surgery. The primary aim of this study was to analyse the effects of a multimodal prehabilitation program in colorectal cancer patients to improve functional capacity. The secondary outcome was to evaluate postoperative complications and length of postoperative hospital stay as well as to determine the costs of implementation and indirect costs. METHODS A single centre, single-blind, randomized controlled trial was conducted. Patients of age > 18 years undergoing elective colorectal resection for colonic cancer were eligible. Exclusion criteria were metastatic disease, severe walking impairments, renal failure stage > 2, ASA score > 3, preoperative chemo-radiation therapy. Patients have been randomized either to prehabilitation intervention groups, receiving 4-week trimodal prehabilitation (physical exercise and nutritional and psychological support) or to control receiving no prehabilitation. Both groups followed enhanced recovery programs and received rehabilitation accordingly. The primary outcome for functional capacity was measured by the 6-Minute Walking Test (6MWT) 4 and 8 weeks after surgery; to evaluate post-operative complications the Clavien-Dindo classification was used. RESULTS An interim analysis of 71 patients undergoing colorectal surgery was performed, with 35 assigned to interventional arm and 36 to control arm. Baseline characteristics were comparable in both groups. The prehabilitation group showed a significant increase in mean 6MWT distance pre-operatively compared to the control group, with an increase of 96 m (523 ± 24.6 vs. 427 ± 25.3, p = 0.01). At 4 and 8 weeks, the prehabilitation group maintained significant improvements, with an increase of 103 m (514 ± 89 vs. 411 ± 115, p = 0.003) and 90 m (531 ± 82 vs. 441 ± 107, p = 0.008), respectively. There were no statistical significant differences in post-operative complications and hospital length of stay between the two groups. CONCLUSIONS The preliminary results of this study indicate that it is feasible to implement a prehabilitation protocol lasting approximately 4 weeks. This protocol appears to yield a significant improvement in the physical performance of patients with colon cancer undergoing elective colorectal resection at 4 and 8 weeks after surgery.
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Affiliation(s)
- Antonio Pesce
- Department of Surgery, Azienda USL of Ferrara and Azienda Ospedaliero Universitaria di Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, Ferrara, Italy.
| | - Nicolò Fabbri
- Department of Surgery, Azienda USL of Ferrara and Azienda Ospedaliero Universitaria di Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, Ferrara, Italy
| | - Simona Colombari
- Clinical Nutrition, Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - Lisa Uccellatori
- Department of Surgery, Azienda USL of Ferrara and Azienda Ospedaliero Universitaria di Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, Ferrara, Italy
| | - Giovanni Grazzi
- Division of Exercise and Sports Medicine, Department of Sports Medicine, Azienda USL di Ferrara, University of Ferrara, Ferrara, Italy
| | - Rosario Lordi
- Division of Exercise and Sports Medicine, Department of Sports Medicine, Azienda USL di Ferrara, University of Ferrara, Ferrara, Italy
| | - Gabriele Anania
- Department of Surgery, Azienda USL of Ferrara and Azienda Ospedaliero Universitaria di Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, Ferrara, Italy
| | - Carlo Vittorio Feo
- Department of Surgery, Azienda USL of Ferrara and Azienda Ospedaliero Universitaria di Ferrara, University of Ferrara, Via Valle Oppio, 2, 44023, Lagosanto, Ferrara, Italy
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Franssen R, Voorn M, Jetten E, Bongers BC, van Osch F, Janssen-Heijnen M. Real-life effectiveness of prehabilitation to improve postoperative outcomes in patients with colorectal cancer approaching surgery: A systematic review and meta-analyses of observational studies versus randomized controlled trials. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108708. [PMID: 39368273 DOI: 10.1016/j.ejso.2024.108708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 09/09/2024] [Accepted: 09/25/2024] [Indexed: 10/07/2024]
Abstract
INTRODUCTION Current evidence synthesis of prehabilitation studies in colorectal surgery is based on results of randomized controlled trials (RCT). Although RCTs are the gold standard for effectiveness research, observational studies probably better reflect real-life practice. The aims of the current study were to compare observational studies to RCTs regarding the association between prehabilitation and postoperative outcomes, and characteristics of included patients and interventions. METHODS A systematic search was conducted in PubMed, Embase, and CINAHL (until September 2023). Observational studies and RCTs investigating prehabilitation before colorectal surgery and reporting postoperative complications and/or length of stay (LoS) were included. Two reviewers independently assessed the risk of bias using the Cochrane Risk of Bias 2 tool for RCTs and the Cochrane ROBINS-I tool for observational studies. Meta(regression)-analyses were performed for postoperative complications and LoS. RESULTS Pooled results showed a statistically significant reduction in postoperative complications (OR 0.54; 95 % confidence interval (CI) 0.40 to 0.72) and LoS (mean difference (MD) -1.34 CI -2.57 to -0.12) after prehabilitation in observational studies but not in RCTs (complications OR 0.95; CI 0.53 to 1.72; LoS MD 0.16 CI -0.52 to 0.83). Patients included in observational studies were older and more often had an ASA score ≥3. In a meta-regression analysis, these characteristics were not statistically significantly associated with the main outcomes. CONCLUSION Observational studies in a real-life setting showed that prehabilitation can reduce postoperative complications and LoS. To further explore the real-life effectiveness of prehabilitation, specific observational study designs, like a target emulation trial could be used.
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Affiliation(s)
- Ruud Franssen
- Department of Clinical Physical Therapy, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - Melissa Voorn
- Adelante Rehabilitation Centre, Venlo, the Netherlands; Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
| | - Evy Jetten
- Department of Orthopedic Surgery, VieCuri Medical Centre, Venlo, the Netherlands; Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands.
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands; Department of Surgery, NUTRIM, Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
| | - Frits van Osch
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, the Netherlands; Department of Epidemiology, GROW Institute for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands.
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Metzner M, Mayson K, Schierbeck G, Wallace T. The implementation of preoperative optimization in British Columbia: a quality improvement initiative. Can J Anaesth 2024; 71:1672-1684. [PMID: 39562426 DOI: 10.1007/s12630-024-02870-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 06/29/2024] [Accepted: 07/03/2024] [Indexed: 11/21/2024] Open
Abstract
PURPOSE Surgical patient optimization is a proactive approach to improve postoperative outcomes. This article reviews the development of the Surgical Patient Optimization Collaborative, an initiative supporting preoperative optimization in British Columbia, Canada. METHODS The Collaborative facilitated optimization programs over two cohorts between 2019 and 2024. A "Change Package" offered screening, intervention, and measurement tools for the following 13 surgical risk factors: anemia, anxiety, body mass index (cohort 2 only), cardiac status, frailty, glycemic control, nutrition, sleep apnea, pain management, physical activity, smoking, social support, substance use, and venous thromboembolism (cohort 1 only). Monthly data submissions from participating sites included the number of patients undergoing optimization, National Surgical Quality Improvement Program-defined 30-day outcomes, length of stay, and patient-reported measures. Run charts were used to analyze the progress of optimization implementation across both cohorts. RESULTS Fourteen sites participated in each cohort. In total, 9,686 patients were screened for optimization, with 7,100/7,505 (95%) patients receiving at least one optimization intervention. Improvement shifts in the number of patients screened were identified in the run charts across both cohorts. Most patients felt that their optimization improved their surgical experience and outcomes. Data for clinical outcomes were inconsistently reported from sites and precluded analyses. Barriers to implementation included project complexity and structural characteristics, and facilitators were knowledge and beliefs about the intervention, reflection, and evaluation. CONCLUSION Preoperative optimization programs were successfully implemented across multiple sites in British Columbia. High-quality clinical outcome analyses are still needed to determine the impact of preoperative optimization on postoperative outcomes. The insight gained from the Collaborative's implementation process may help inform future multicentre preoperative optimization efforts.
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Affiliation(s)
- Micheline Metzner
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Kelly Mayson
- Department of Anesthesia and Perioperative Care, Vancouver General Hospital, Vancouver, BC, Canada.
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.
- Jim Pattison Pavilion North, Vancouver General Hospital, 899 West 12th Avenue, Room 3400, Vancouver, BC, V5Z 1M9, Canada.
| | | | - Thomas Wallace
- Department of Surgery, Royal Inland Hospital, Kamloops, BC, Canada
- Department of Surgery, The University of British Columbia, Vancouver, BC, Canada
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Mayer A, Cibula D. Optimizing prehabilitation in gynecologic malignancies: Improving acceptance, overcoming barriers, and managing program complexity. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108739. [PMID: 39418833 DOI: 10.1016/j.ejso.2024.108739] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/23/2024] [Accepted: 10/01/2024] [Indexed: 10/19/2024]
Abstract
Prehabilitation aims to improve patients' physical condition before a stressful event, such as surgery, and enhance recovery. Despite its potential benefits, many emerging prehabilitation programs face challenges in enrolling or retaining patients. In our prehabilitation study PHOCUS, which aims to prepare ovarian cancer patients for surgery, we have also encountered lower acceptance and retention rates. Particularly the most vulnerable patients, who are old and frail, and may benefit the most from the prehabilitation, decline participation due to the complexity of the proposed program. In our review we discussed obstacles and barriers that prevent patients' participation based on both literature and our experience. Among the main reasons are patient's low motivation, high intensity of the program and a lack of social support. To overcome these challenges, we suggest increasing the program's flexibility, adapting the program according to individual patient's needs and enhancing patients' education about the benefits of prehabilitation.
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Affiliation(s)
- Alexandra Mayer
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - David Cibula
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
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McIsaac DI, Tandon P, Kidd G, Branje K, Hladkowicz E, Hallet J, Wijeysundera DN, Lee S, McNeely ML, Taljaard M, Gillis C. STRIVE pilot trial: a protocol for a multicentre pragmatic internal pilot randomised controlled trial of Structured TRaining to Improve fitness in a Virtual Environment (STRIVE) before surgery. BMJ Open 2024; 14:e093710. [PMID: 39510784 PMCID: PMC11552010 DOI: 10.1136/bmjopen-2024-093710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Accepted: 10/24/2024] [Indexed: 11/15/2024] Open
Abstract
INTRODUCTION Home-based, virtually-supported care models may represent the most efficient and scalable approach to delivering prehabilitation services. However, virtual approaches to prehabilitation are understudied. This manuscript describes the protocol for an internal pilot randomised controlled trial of a virtually-delivered, multimodal prehabilitation intervention. METHODS AND ANALYSIS We will conduct a pragmatic, individual patient, internal pilot randomised controlled trial of home-based, virtually supported, multimodal prehabilitation compared with standard perioperative care in adults undergoing elective, inpatient thoracic, abdominal, pelvic and vascular surgery at five Canadian hospitals. Participants will be partially blinded; clinicians and outcome assessors will be fully blinded. The intervention consists of 3-12 weeks of a home-based, multimodal (exercise, nutrition and psychosocial support) prehabilitation programme supported through an online platform. The primary feasibility outcomes and their progression targets are (1) monthly recruitment of>6 participants at each centre, (2) intervention adherence of>75%, (3) retention of>90% of participants at the patient-reported primary outcome point of 30-days after surgery and (4) elicitation of patient, clinician and researcher-identified barriers to our pragmatic trial. A sample size of 144 participants will be adequate to estimate recruitment, adherence and retention rates with acceptable precision. All participants will be followed to either death or up to 1 year. As an internal pilot, if no substantive changes to the trial or intervention design are required, pilot participant outcome data will migrate, unanalysed by allocation, to the future full-scale trial. ETHICS AND DISSEMINATION Ethical approval has been granted by Clinical Trials Ontario (Project ID: 4479) and our ethics review board (Protocol Approval #20230399-01T). Results will be disseminated through presentations at scientific conferences, peer-reviewed publications, partner organisations and engagement of social and traditional media. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT06042491. Protocol, V.1.2, dated 6 June 2024.
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Affiliation(s)
- Daniel I McIsaac
- Anaesthesiology and Pain Medicine, Ottawa Hospital Research Institute Clinical Epidemiology Programme, Ottawa, Ontario, Canada
| | - Puneeta Tandon
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Gurlavine Kidd
- Patient Partner, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Karina Branje
- Department of Anaesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emily Hladkowicz
- Departments of Anaesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Julie Hallet
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Susan Lee
- Department of Anesthesiology, Pharmacology, and Therapeutics, UBC Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Margaret L McNeely
- Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Supportive Care, Cancer Care Alberta, Edmonton, Alberta, Canada
| | - Monica Taljaard
- Clinical Epidemiology Programme, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, Québec, Canada
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Finch A, Ashford S, Taylor C. Implementing a physiotherapy-led prehabilitation service and improving inpatient rehabilitation for people with complex colorectal cancer: a service evaluation project. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2024; 31:1-17. [DOI: 10.12968/ijtr.2023.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Background/Aims Prehabilitation improves pre-operative functional status which improves post-operative outcomes. There is limited evidence on the role prehabilitation for people with locally advanced or recurrent colorectal cancer and because of the complex nature of the surgery, patients have particular need for optimisation and specialist rehabilitation. A service evaluation was implemented to evaluate the impact of prehabilitation and increased post-operative rehabilitation in those with locally advanced or recurrent colorectal cancer. Methods Exercise-based prehabilitation and an increase in inpatient rehabilitation was implemented for those referred to the complex colorectal cancer clinic (n=59). Hospital length of stay and number of inpatient physiotherapy contacts (therapy sessions) were collected between May 2021 and May 2022 and compared to retrospective data of 44 people who underwent surgery between 2018 and 2019 to help evaluate this project. A range of secondary outcome measures were also collected to assess the impact of prehabilitation, including the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core-30, 30-Second Sit-to-Stand Test, Duke Activity Status Index and a patient questionnaire. Paired sample t-tests were performed to compare the total hospital length of stay for all patients in the retrospective 2018–2019 data group with the prehabilitation data group from 2021–2022. Results A total of 59 patients entered the service between May 2021 and May 2022. A significant difference between the length of stay in the two groups was found (P<0.05, t=0.731). Improvements in the Sit-to-Stand Test and Duke Activity Status Index were demonstrated (P<0.001). Data from the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaire Core-30 showed small but not significant reductions in the severity of physical, fatigue, pain and appetite functioning scales. For the more complex patients, average weekly inpatient physiotherapy contacts per person increased from three in 2018–2019 to seven in 2021–2022. Patient compliance and satisfaction was high following implementation of the service development project. Conclusions Prehabilitation improves pre-operative functional status and combined with effective inpatient rehabilitation, may reduce hospital length of stay for those undergoing complex colorectal cancer surgery. Implications for practice Services that offer surgery for locally advanced or recurrent colorectal cancer should consider implementing a prehabilitation programme to improve pre-operative functional status. For those undergoing more complex surgeries, increased post-operative rehabilitation provision should be considered, as combined with prehabilitation, it may reduce hospital length of stay.
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Affiliation(s)
- Alice Finch
- St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Stephen Ashford
- Regional Hyperacute Rehabilitation Unit, London Northwest University Healthcare NHS Trust, London, UK
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Claire Taylor
- St Mark's Hospital, London Northwest University Healthcare NHS Trust, London, UK
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Steffens D, Nott F, Koh C, Jiang W, Hirst N, Cole R, Karunaratne S, West MA, Jack S, Solomon MJ. Effectiveness of Prehabilitation Modalities on Postoperative Outcomes Following Colorectal Cancer Surgery: A Systematic Review of Randomised Controlled Trials. Ann Surg Oncol 2024; 31:7822-7849. [PMID: 38914837 PMCID: PMC11467005 DOI: 10.1245/s10434-024-15593-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/28/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Postoperative morbidity in patients undergoing curative colorectal cancer surgery is high. Prehabilitation has been suggested to reduce postoperative morbidity, however its effectiveness is still lacking. OBJECTIVE The aim of this study was to investigate the effectiveness of prehabilitation in reducing postoperative morbidity and length of hospital stay in patients undergoing colorectal cancer surgery. METHODS A comprehensive electronic search was conducted in the CINAHL, Cochrane Library, Medline, PsychINFO, AMED, and Embase databases from inception to April 2023. Randomised controlled trials testing the effectiveness of prehabilitation, including exercise, nutrition, and/or psychological interventions, compared with usual care in patients undergoing colorectal cancer surgery were included. Two independent review authors extracted relevant information and assessed the risk of bias. Random-effect meta-analyses were used to pool outcomes, and the quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines. RESULTS A total of 23 trials were identified (N = 2475 patients), including multimodal (3 trials), exercise (3 trials), nutrition (16 trials), and psychological (1 trial) prehabilitation. There was moderate-quality evidence that preoperative nutrition significantly reduced postoperative infectious complications (relative risk 0.65, 95% confidence interval [CI] 0.45-0.94) and low-quality evidence on reducing the length of hospital stay (mean difference 0.87, 95% CI 0.17-1.58) compared with control. A single trial demonstrated an effect of multimodal prehabilitation on postoperative complication. CONCLUSION Nutrition prehabilitation was effective in reducing infectious complications and length of hospital stay. Whether other multimodal, exercise, and psychological prehabilitation modalities improve postoperative outcomes after colorectal cancer surgery is uncertain as the current quality of evidence is low. PROTOCOL REGISTRATION Open Science Framework ( https://doi.org/10.17605/OSF.IO/VW72N ).
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Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia.
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Finley Nott
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Wilson Jiang
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Nicholas Hirst
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Ruby Cole
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Malcolm A West
- Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- National Institute for Health and Social Care Research, Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University Hospitals Southampton, Southampton, UK
| | - Sandy Jack
- National Institute for Health and Social Care Research, Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University Hospitals Southampton, Southampton, UK
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia
- Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Garoufalia Z, Emile SH, Meknarit S, Gefen R, Horesh N, Zhou P, Aeschbacher P, Strassmann V, Wexner SD. A systematic review and meta-analysis of high-quality randomized controlled trials on the role of prehabilitation programs in colorectal surgery. Surgery 2024; 176:1352-1359. [PMID: 39147666 DOI: 10.1016/j.surg.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Prehabilitation is gaining popularity in colorectal surgery but lacks high-quality postoperative outcomes data. This meta-analysis explored whether prehabilitation impacts postoperative outcomes. METHODS In this meta-analysis, compliant with Preferred Reporting Items for Systematic reviews and Meta-Analyses, we searched PubMed and Scopus through November 2022. High-quality randomized control trials involving adults who underwent colorectal surgery with/without exercise-based prehabilitation were included. The main outcomes were short-term postoperative morbidity, readmissions, and length of stay. Random-effect meta-analyses were performed, and statistical heterogeneity was assessed using the I2 statistic. RESULTS Seven high-quality randomized control trials comprising 1,225 patients were included. The median prehabilitation duration was 4 (2-4) weeks. Four studies compared prehabilitation and standard of care, and 3 compared prehabilitation and rehabilitation. Exercise-based prehabilitation did not reduce the odds of short-term complications (odds ratio 0.62, 95% confidence interval 0.27-1.40, P = .25, I2 = 68%) or readmission (odds ratio 1, 95% confidence interval 0.73-1.46, P = .85, I2 = 0%). The prehabilitation group had shorter length of hospital stay (weighted mean difference -0.2, 95% confidence interval -0.25 to -0.14, P < .0001, I2 = 43.3%). Prehabilitation and rehabilitation had similar odds of short-term complications (odds ratio 1.03, 95% confidence interval 0.56-1.89, P = .91, I2 = 33%), length of stay (weighted mean difference -0.16, 95% confidence interval -0.47 to 0.16, P = .33, I2 = 59%), and readmission (odds ratio 1.25, 95% confidence interval 0.28-5.56, P = .77, I2 = 52%). The only benefit of prehabilitation over rehabilitation was better 6-minute walking distance test results at time of surgery (weighted mean difference: -9.4 m; 95% confidence interval -18.04 to 0.79, P = .03, I2 = 42%). CONCLUSION Prehabilitation provided decreased postoperative length of hospital stay and improved preoperative functional outcomes, but not reduced odds of complications and/or readmissions. Prehabilitation and rehabilitation had similar clinical outcomes.
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Affiliation(s)
- Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://www.twitter.com/ZGaroufalia
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Egypt. https://www.twitter.com/dr_samehhany81
| | - Sarinya Meknarit
- Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, FL
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of General Surgery, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel. https://www.twitter.com/rachellgefen
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of Surgery and Transplantations, Sheba Medical Center, Ramat Gan, Israel. https://www.twitter.com/nirhoresh
| | - Peige Zhou
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Georgia Colon and Rectal Surgical Associates, Northside Hospital, Atlanta, GA
| | - Pauline Aeschbacher
- Department of General Surgery and Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL; Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland. https://www.twitter.com/PaAeschbacher
| | - Victor Strassmann
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL.
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Zhou L, Li H, Zhang Z, Wang L. Effects of multimodal prehabilitation and exercise prehabilitation on patients undergoing colorectal surgery: A systematic review and meta-analysis of randomised controlled trials. J Glob Health 2024; 14:04239. [PMID: 39451060 PMCID: PMC11505574 DOI: 10.7189/jogh.14.04239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2024] Open
Abstract
Background Multimodal prehabilitation and exercise prehabilitation are important processes for patients undergoing colorectal surgery. There are no reviews simultaneously analysing the effects of both types of prehabilitation for patients undergoing colorectal surgery. Methods We searched PubMed, Embase, Scopus, Web of Science, the Cochrane Library, ProQuest, and CINAHL Plus with Full Text for relevant randomised controlled trials on multimodal prehabilitation and exercise prehabilitation. The primary outcomes in our meta-analysis were functional capacity, hospital length of stay, postoperative complications, anxiety, and depression scores. Results We included 17 studies involving 1961 for colorectal surgery patients. The results of the meta-analysis suggested that multimodal prehabilitation could improve functional capacity (the 6-minute walk test) in patients undergoing colorectal surgery (mean difference (MD) = 29.00; 95% confidence interval (CI) = 26.64-31.36). In the subgroup analysis, multimodal prehabilitation improved functional capacity only preoperatively (MD = 34.77; 95% CI = 16.76-52.77) and did not improve the length of stay, postoperative complication, and anxiety and depression scores. Exercise prehabilitation did not show a positive effect on functional capacity, the length of stay, postoperative complication, and anxiety and depression scores. Conclusions Compared with exercise prehabilitation, multimodal prehabilitation was more likely improve the functional ability of patients undergoing colorectal surgery. Besides, the effects of multimodal prehabilitation or exercise prehabilitation on the length of stay, postoperative complications and anxiety and depression scores of colorectal surgery patients were not found. Registration PROSPERO: CRD42023453438.
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Affiliation(s)
- Lu Zhou
- Department of Nursing, Peking University People’s Hospital, Beijing, China
- School of Nursing, Peking University, Beijing, China
| | - Hui Li
- Department of Nursing, Peking University People’s Hospital, Beijing, China
- School of Nursing, Peking University, Beijing, China
| | - Zhengyang Zhang
- Department of Nursing, Peking University People’s Hospital, Beijing, China
- School of Nursing, Peking University, Beijing, China
| | - Ling Wang
- Department of Nursing, Peking University People’s Hospital, Beijing, China
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Gennuso D, Baldelli A, Gigli L, Ruotolo I, Galeoto G, Gaburri D, Sellitto G. Efficacy of Prehabilitation in cancer patients: an Rcts systematic review with meta-analysis. BMC Cancer 2024; 24:1302. [PMID: 39438910 PMCID: PMC11494964 DOI: 10.1186/s12885-024-13023-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 10/03/2024] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Patients with cancer (PwC) who undergo specific treatments reported greater fatigue and reduced functional capacity as predominant outcomes, compromising their QoL during and following the treatment. Prehabilitation intervention, provided after diagnosis and before treatments, is to optimize the physiological reserve and address modifiable risk factors before surgery or chemotherapy to improve post-treatment results. The primary aim of this study is to obtain a common line of efficacy compared with prehabilitation treatment; the secondary endpoint is to assess the methodological quality of the studies eligible in the review. METHODS The systematic review was conducted from September to February 2024, in accordance with PRISMA guidelines. Databases consulted were MEDLINE, Scopus, Web of science and CINAHL, RCTs related to Prehabilitation intervention on PwC were included. The methodological quality of the included studies was assessed through the RoB2 Cochrane tool and the PEDro scale. Meta-analysis was performed to estimate relative treatment effects among evaluated outcomes. RESULTS Forty-two studies were included in the systematic review, 13 were included in the quantitative analysis. The results of the studies reporting reduced postoperative hospital stay, improved endurance, muscle strength, respiratory function, quality of life, and urinary incontinence. Critical analysis of the articles using the PEDro scale revealed 28 RCTs with a good rating, 9 with a fair rating, and 5 with a poor rating; in contrast, the Cochrane RoB2 tool revealed that all articles were at high risk of bias. Meta-analysis showed statistically significant values for 6MWT (38.53, 95%CI 33.03 - 44.04); HADS-depression (-0.71, 95%CI -0.93 -0.49) and HADS-anxiety (-0.49, 95%CI -0.76 -0.23). CONCLUSIONS Prehabilitation represents a specific intervention that aims to improve postoperative outcomes in fragile patients undergoing surgery, increasing their preoperative physiological reserve in anticipation of the stress they will face and facilitating the postoperative recovery of functional capacity. Prehabilitation is a good intervention to use, especially in terms of functional capacity and mental health, the latter being very impactful in terms of reduced levels of anxiety and depression. These data make it possible to justify supportive intervention by physical therapists aimed at improving and restoring health-related QoL especially in the short term.
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Affiliation(s)
- Daniele Gennuso
- Department of Rehabilitation, Asl Roma 3, 00122, Rome, Italy
| | - Angela Baldelli
- Fisiolab, Via Madonna Delle Grazie 5/A, 06055, Marsciano, PG, Italy
| | - Loredana Gigli
- Department of Rehabilitation, Asl Roma 3, 00122, Rome, Italy
| | - Ilaria Ruotolo
- Department of Anatomical, Histological, Forensic and Orthopaedical Sciences, Sapienza University of Rome, Rome, 00185, Italy
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Giovanni Galeoto
- Department of Anatomical, Histological, Forensic and Orthopaedical Sciences, Sapienza University of Rome, Rome, 00185, Italy
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Daniela Gaburri
- Department of Medicine, University of Perugia, Perugia, Italy
| | - Giovanni Sellitto
- Department of Human Neurosciences, Sapienza University, Rome, Italy.
- MS Center, S. Andrea Hospital, Sapienza University, Rome, Italy.
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Damanti S, Senini E, De Lorenzo R, Merolla A, Santoro S, Festorazzi C, Messina M, Vitali G, Sciorati C, Rovere-Querini P. Acute Sarcopenia: Mechanisms and Management. Nutrients 2024; 16:3428. [PMID: 39458423 PMCID: PMC11510680 DOI: 10.3390/nu16203428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 09/27/2024] [Accepted: 10/07/2024] [Indexed: 10/28/2024] Open
Abstract
BACKGROUND Acute sarcopenia refers to the swift decline in muscle function and mass following acute events such as illness, surgery, trauma, or burns that presents significant challenges in hospitalized older adults. METHODS narrative review to describe the mechanisms and management of acute sarcopenia. RESULTS The prevalence of acute sarcopenia ranges from 28% to 69%, likely underdiagnosed due to the absence of muscle mass and function assessments in most clinical settings. Systemic inflammation, immune-endocrine dysregulation, and anabolic resistance are identified as key pathophysiological factors. Interventions include early mobilization, resistance exercise, neuromuscular electrical stimulation, and nutritional strategies such as protein supplementation, leucine, β-hydroxy-β-methyl-butyrate, omega-3 fatty acids, and creatine monohydrate. Pharmaceuticals show variable efficacy. CONCLUSIONS Future research should prioritize serial monitoring of muscle parameters, identification of predictive biomarkers, and the involvement of multidisciplinary teams from hospital admission to address sarcopenia. Early and targeted interventions are crucial to improve outcomes and prevent long-term disability associated with acute sarcopenia.
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Affiliation(s)
- Sarah Damanti
- Internal Medicine Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (S.D.); (G.V.); (P.R.-Q.)
- Division of Immunology, Transplantation and Infectious Diseases, Vita-Salute San Raffaele University, 20100 Milan, Italy; (E.S.); (R.D.L.); (A.M.); (S.S.); (C.F.); (M.M.)
| | - Eleonora Senini
- Division of Immunology, Transplantation and Infectious Diseases, Vita-Salute San Raffaele University, 20100 Milan, Italy; (E.S.); (R.D.L.); (A.M.); (S.S.); (C.F.); (M.M.)
| | - Rebecca De Lorenzo
- Division of Immunology, Transplantation and Infectious Diseases, Vita-Salute San Raffaele University, 20100 Milan, Italy; (E.S.); (R.D.L.); (A.M.); (S.S.); (C.F.); (M.M.)
| | - Aurora Merolla
- Division of Immunology, Transplantation and Infectious Diseases, Vita-Salute San Raffaele University, 20100 Milan, Italy; (E.S.); (R.D.L.); (A.M.); (S.S.); (C.F.); (M.M.)
| | - Simona Santoro
- Division of Immunology, Transplantation and Infectious Diseases, Vita-Salute San Raffaele University, 20100 Milan, Italy; (E.S.); (R.D.L.); (A.M.); (S.S.); (C.F.); (M.M.)
| | - Costanza Festorazzi
- Division of Immunology, Transplantation and Infectious Diseases, Vita-Salute San Raffaele University, 20100 Milan, Italy; (E.S.); (R.D.L.); (A.M.); (S.S.); (C.F.); (M.M.)
| | - Marco Messina
- Division of Immunology, Transplantation and Infectious Diseases, Vita-Salute San Raffaele University, 20100 Milan, Italy; (E.S.); (R.D.L.); (A.M.); (S.S.); (C.F.); (M.M.)
| | - Giordano Vitali
- Internal Medicine Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (S.D.); (G.V.); (P.R.-Q.)
| | - Clara Sciorati
- Division of Immunology, Transplantation and Infectious Diseases, Vita-Salute San Raffaele University, 20100 Milan, Italy; (E.S.); (R.D.L.); (A.M.); (S.S.); (C.F.); (M.M.)
| | - Patrizia Rovere-Querini
- Internal Medicine Unit, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (S.D.); (G.V.); (P.R.-Q.)
- Division of Immunology, Transplantation and Infectious Diseases, Vita-Salute San Raffaele University, 20100 Milan, Italy; (E.S.); (R.D.L.); (A.M.); (S.S.); (C.F.); (M.M.)
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Beukers K, Franssen RFW, Beijaard K, van de Wouw AJ, Havermans RC, Janssen-Heijnen MLG. Nutritional intervention during a teleprehabilitation pilot study in high-risk patients with colorectal cancer: adherence, motivators, and barriers. Support Care Cancer 2024; 32:710. [PMID: 39375223 PMCID: PMC11458744 DOI: 10.1007/s00520-024-08915-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 10/01/2024] [Indexed: 10/09/2024]
Abstract
PURPOSE The preoperative period provides a window of opportunity to improve modifiable risk factors for treatment complications such as malnutrition, the so-called prehabilitation. Identifying factors related to adherence to nutritional interventions is essential for optimizing prehabilitation programs. The aim of this study is to evaluate a nutritional support module as part of a teleprehabilitation program in high-risk patients with colorectal cancer (CRC). METHODS A secondary analysis with a mixed method design of the nutritional support module of a pre-post teleprehabilitation pilot study was performed. Change in weight, complaints with intake, motivation, and subjective and objective adherence were evaluated. RESULTS Eleven patients were included. Subjectively, six patients (55%) were able to adhere to the nutritional advice. Despite that, nine of eleven (82%) patients experienced difficulties with the amount of food that was advised by the dietician. Six of eleven (55%) patients gained weight during the prehabilitation program. After prehabilitation, nine of eleven (82%) were able to reach 100% of their energy requirement and six of eleven (55%) were able to reach 100% of their protein requirement. Differences between patients in motivation and/or having complaints did not seem to be associated with protein and energy intake. CONCLUSION This secondary analysis of a pilot study provides insights into understanding patients' experiences with a nutritional support module as part of a teleprehabilitation program. With 82% of patients who were able to reach 100% of their energy requirement, teleprehabilitation seems to be feasible, while there is still room for improvement with respect to protein intake as only 55% of patients reached a sufficient intake.
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Affiliation(s)
- K Beukers
- Department of Internal Medicine, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands.
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands.
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - R F W Franssen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Clinical Physical Therapy, VieCuri Medical Centre, Venlo, The Netherlands
| | - K Beijaard
- Department of Dietetics, VieCuri Medical Centre, Venlo, The Netherlands
| | - A J van de Wouw
- Department of Internal Medicine, VieCuri Medical Centre, Tegelseweg 210, 5912 BL, Venlo, The Netherlands
| | - R C Havermans
- Department of Youth, Food, and Health, Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - M L G Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Weiss Y, Matot I. Frailty; Time for Global Action : Commentary on "Frailty and its Association with Long-Term Mortality among Community-Dwelling older adults aged 75 years and Over". Isr J Health Policy Res 2024; 13:57. [PMID: 39363336 PMCID: PMC11451099 DOI: 10.1186/s13584-024-00646-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 09/26/2024] [Indexed: 10/05/2024] Open
Abstract
This commentary examines the study "Frailty and Its Association with Long-Term Mortality Among Community-Dwelling Older Adults Aged 75 Years and Over" by Lewis et al. The retrospective cohort study utilized data from a primary healthcare provider in Israel to investigate frailty using the Frailty Index (FI) and its correlation with long-term mortality. Nearly half of the older adult cohort was identified as frail, with a strong association between higher frailty levels and increased mortality risk. The commentary emphasizes the importance of routine frailty screening in clinical practice and health policy. Integrating FI calculations into electronic health records can facilitate timely care for high-risk individuals. However, presenting frailty data must be managed carefully and in conjunction with patients' preferences to avoid stigmatizing and negatively influencing clinical decisions. While the FI is a valuable tool, it should complement, not replace, other assessments that provide a more holistic view of the patient's health. Furthermore, the commentary strongly advocates for a more comprehensive approach to patient care, emphasizing that non-geriatricians must also be proficient in recognizing and managing frailty. Effectively addressing frailty can lead to significant cost savings for healthcare systems, reduced burden on healthcare facilities, and decreased need for long-term care.
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Affiliation(s)
- Yotam Weiss
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel- Aviv University, 6 Weizmann St, Tel-Aviv, 6423906, Israel.
| | - Idit Matot
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel- Aviv University, 6 Weizmann St, Tel-Aviv, 6423906, Israel
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Alsuwaylihi A, Skořepa P, Prado CM, Gomez D, Lobo DN, O'Connor D. Exploring the acceptability of and adherence to prehabilitation and rehabilitation in patients undergoing major abdominal surgery: A systematic review and meta-analysis. Clin Nutr ESPEN 2024; 63:709-726. [PMID: 39142632 DOI: 10.1016/j.clnesp.2024.07.1060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND AND AIMS Prehabilitation combines exercise, nutritional, and psychological interventions administered before surgery to improve patient outcomes. This comprehensive review and meta-analysis examined the feasibility, adherence, and effectiveness of prehabilitation in frail, high-risk individuals undergoing major abdominal surgery. METHODS We searched the Cochrane Central Register of Controlled Trials, Web of Science, MEDLINE, Embase, and Cumulative Index to Nursing & Allied Health Literature (CINAHL) databases to identify relevant studies evaluating prehabilitation programs published between 2010 and 2023, either as observational studies or randomized clinical trials (RCTs). RESULTS The 23 articles (13 RCTs and 10 observational studies) included 1849 older male and female patients aged 68.7 ± 7.2 years. Nineteen of the included studies reported on adherence to prehabilitation programmes, which was generally good (>75%) over different models, settings, and durations. Factors such as patients' desire for expedited surgery, self-assessment of fitness, personal and professional obligations, health issues, holidays, and advancement of surgery dates negatively affected adherence to prehabilitation programmes. When compared with rehabilitation or standard pre- and post-surgical care, prehabilitation was associated with a 25%, albeit not statistically significant reduction in postoperative complications, according to data from 14 studies reporting on postoperative complications (OR 0.75, 95% CI 0.48 to 1.17, P = 0.43; I2 = 65%). Prehabilitation has been found to improve the 6-min walk test significantly by 29.4 m (MD +29.4 m, 95% CI 5.6 to 53.3, P = 0.02; I2 = 39%), compared with rehabilitation or standard pre- and post-surgical care. CONCLUSION Prehabilitation was acceptable to patients, with good adherence, and improved physical function.
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Affiliation(s)
- Abdulaziz Alsuwaylihi
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; Department of Clinical Nutrition, King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia. https://twitter.com/AbdulAz1z4_4
| | - Pavel Skořepa
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; University of Defence, Military Faculty of Medicine, Department of Military Internal Medicine and Military Hygiene, Hradec Kralove, Czech Republic; 3rd Department of Internal Medicine-Metabolic Care and Gerontology, University Hospital and Faculty of Medicine in Hradec Králové, Charles University in Prague, Hradec Králové, Czech Republic. https://twitter.com/Pavel_Skorepa_
| | - Carla M Prado
- Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Canada. https://twitter.com/DrCarlaPrado
| | - Dhanny Gomez
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Dileep N Lobo
- Nottingham Digestive Diseases Centre, Division of Translational Medical Sciences, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK; National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham, UK; MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK; Divison of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Dominic O'Connor
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK. https://twitter.com/Dom_OConnor1
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Chang GJ, Gunn HJ, Barber AK, Lowenstein LM, Dohan D, Broering J, Dockter T, Tan AD, Dueck A, Chow S, Neuman H, Finlayson E. Improving Surgical Care and Outcomes in Older Cancer Patients Through Implementation of a Presurgical Toolkit (OPTI-Surg)-Final Results of a Phase III Cluster Randomized Trial (Alliance A231601CD). Ann Surg 2024; 280:623-632. [PMID: 39069901 PMCID: PMC11728768 DOI: 10.1097/sla.0000000000006458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To assess the effect of a practice-level preoperative frailty screening and optimization toolkit (OPTI-Surg) on postoperative functional recovery and complications in elderly cancer patients undergoing major surgery. BACKGROUND Frailty is common in older adults. It increases the risk of poor postoperative functional recovery and complications. The potential for a practice-level screening/optimization intervention to improve outcomes is unknown. METHODS Thoracic, gastrointestinal, and urologic oncological surgery practices within the National Cancer Institute Community Oncology Research Program (NCORP) were randomized 1:1:1 to usual care (UC), OPTI-Surg, or OPTI-Surg with an implementation coach. OPTI-Surg consisted of the Edmonton Frail Scale and guided recommendations for referral interventions. Patients 70 years old or above undergoing curative intent surgery were eligible. The primary outcome was 8 weeks postoperative function (kcal/wk). The key secondary outcome was complications within 90 days. Mixed models were used to compare UC to the 2 OPTI-Surg arms combined. RESULTS From July 2019 to September 2022, 325 patients were enrolled in 29 practices. One hundred ninety-nine (64 UC, 135 OPTI-Surg) and 279 (78 UC, 201 OPTI-Surg) were evaluable for primary and secondary analysis, respectively. UC and OPTI-Surg patients did not significantly differ in total caloric expenditure (2.2 UC, 2.0 OPTI-Surg) after adjusting for baseline function ( P =0.53). UC and OPTI-Surg patients did not significantly differ in postoperative complications (25.6% UC, 35.3% OPTI-Surg, P =0.5). CONCLUSIONS Frailty assessment was successfully performed, but the OPTI-Surg intervention did not improve postoperative function nor reduce postoperative complications compared with UC. Future analysis will explore practice-level factors associated with toolkit implementation and the differences between the coaching and noncoaching arms.
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Affiliation(s)
- George J. Chang
- Department of Colon and Rectal Surgery, the University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Health Services Research, the University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Heather J. Gunn
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | | | - Lisa M. Lowenstein
- Department of Health Services Research, the University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Daniel Dohan
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | | | - Travis Dockter
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Angelina D. Tan
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Amylou Dueck
- Alliance Statistics and Data Management Center, Scottsdale, AZ
| | - Selina Chow
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL
| | - Heather Neuman
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Emily Finlayson
- Department of Surgery, University of California, San Francisco, CA
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