Prehabilitation Programs Improve Exercise Capacity Before and After Surgery in Gastrointestinal Cancer Surgery Patients:
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ORIGINAL ARTICLE
Prehabilitation Programs Improve Exercise Capacity Before and After Surgery in Gastrointestinal Cancer Surgery Patients: A Meta-Analysis Christine S. M. Lau 1
&
Ronald S. Chamberlain 1,2
Received: 15 July 2019 / Accepted: 19 October 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Introduction Prehabilitation programs or interventions are employed prior to surgery with the aim to optimize the patient before surgery and to improve their physiologic ability to recover from surgery. Components of these programs often include exercise, nutritional supplementation, and psychological interventions. This meta-analysis examines the impact of prehabilitation programs on both surgical and patient outcomes among gastrointestinal (GI) cancer patients undergoing surgery. Methods A comprehensive literature search was conducted to identify all published randomized control trials (RCT) evaluating the use of prehabilitation programs (with one or more interventions) in GI cancer surgery patients. Outcomes assessed were 6-min walk distance (6MWD), postoperative complications, major complications (as defined as Clavien Dindo grade ≥ 3), surgical site infections (SSI), pneumonia, length of stay (LOS), 30-day readmission, and mortality. Results Eleven RCTs including 929 patients (475 prehabilitation program and 454 controls) were analyzed. Prehabilitation programs were associated with statistically significant improvements in 6MWD between baseline and immediately prior to surgery (MD = 32.542 m; 95% CI, 10.774–54.310; p = 0.003) and 4–8 weeks after surgery (MD = 48.220 m; 95% CI, 1.532–94.908; p = 0.043) compared with patients who did not receive prehabilitation programs. Similar rates of postoperative complications, major complications, SSI, pneumonia, 30-day readmission, and mortality, as well as LOS, were observed (p > 0.05). Conclusions Prehabilitation programs improve exercise capacity both before and after surgery, with no significant difference in LOS, or rates of postoperative complications, 30-day readmission, and mortality. Future studies assessing the different components of prehabilitation programs to identify the most beneficial interventions are required. Keywords Prehabilitation . Preoperative . Nutrition . Exercise . Gastrointestinal . Cancer . Surgery
Introduction Surgical resection is often required in the treatment of gastrointestinal (GI) cancers.1, 2 Despite its survival benefits, surgery may be associated with significant postoperative complications, which in turn impair functional capacity, impede postoperative recovery, increase healthcare costs, and decrease quality of life (QoL).1–3 Only 40% of patients receiving standard of care return to baseline physical activity levels at 8 week following surgery.4
* Ronald S. Chamberlain [email protected] 1
Abrazo Community Health Network Abrazo Central Campus, Phoenix AZ USA
2
Arizona Cancer Surgery Specialists, Abrazo Medical Group, 3811 E. Bell Road, Suite 309 Phoenix AZ 85032 USA
Prehabilitation programs are a set of in
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