Role of prehabilitation following major uro-oncologic surgery: a narrative review
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TOPIC PAPER
Role of prehabilitation following major uro‑oncologic surgery: a narrative review Enrico Maria Minnella1,2 · Francesco Carli1 · Wassim Kassouf3 Received: 30 August 2020 / Accepted: 15 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Functional status and physical independence play a key role in terms of quality of life, access to treatment, and continuity of care. Surgery, a central component of cancer treatments, leads to detrimental effects on functional capacity, which can be peculiarly relevant in vulnerable patients undergoing major procedures. Prehabilitation is a multidisciplinary intervention that uses the preoperative period to prevent or attenuate treatment-related functional decline and its subsequent consequences. This paper narratively reviews the rationale and the evidence of prehabilitation for uro-oncologic surgery. Methods A narrative review was conducted in August 2020, aiming to: (1) identify and discuss the impact of modifiable determinants of postoperative outcomes in urology and (2) review randomized controlled trials (RCT) exploring the role of preoperative exercise, nutrition, and psychological interventions in uro-oncologic surgery. Results Eight RCTs on preoperative conditioning interventions met the inclusion criteria, focusing on radical cystectomy for bladder cancer (RC) and radical prostatectomy for prostate cancer (RP). There is strong evidence that poor physical, nutritional and psychosocial status negatively impacts on surgical outcomes. Single modality interventions, such as preoperative exercise or nutrition alone, had no effect on ‘traditional’ surgical outcomes as length of stay or complication. However, multimodal approaches targeting postoperative functional status have shown to be effective and safe. Conclusion There is initial evidence on the effectiveness and safety of multimodal prehabilitation in preserving functional capacity following RC and RP. However, to date, outcomes such as complications and length of stay seem to be not affected by prehabilitation. Keywords Prehabilitation · Functional capacity · ERAS · Radical cystectomy · Radical prostatectomy · Quality of life
Introduction Over the last decade, uro-oncology has been revolutionized by the increasing adoption of neoadjuvant treatment, enhanced recovery pathway, and minimally invasive surgery. However, surgical and long-term outcomes have remained largely unchanged [1–3].
* Enrico Maria Minnella [email protected] 1
Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada
2
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
3
Department of Urology, McGill University Health Centre, Montreal, QC, Canada
Furthermore, while the excision of the primary solid cancer is life saving [4, 5], the maintenance of health-related quality of life has become a pivotal outcome in surgical care. This can be challenging, as all components of physical fu
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