A Narrative Review About Prehabilitation in Surgery: Current Situation and Future Perspectives

Rodríguez‐Arias, Francisco López; Sánchez‐Guillén, Luis; Ruiz, Laura Irene Armañanzas; Lara, Carlos Díaz; Gómez, F; Pons, Carmen Balagué; Rodríguez, José Manuel ́Ramírez; Arroyo, Antonio

doi:10.1016/j.cireng.2020.03.014

Cited by 7 publications

(5 citation statements)

References 53 publications

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“…From the concepts of high risk of patients with comorbidities and frailty has emerged the concept of prehabilitation [77]. Prehabilitation is defined as a process of improving the functional capability of a patient prior to a surgical procedure.…”

Section: Prehabilitationmentioning

confidence: 99%

Management of Older Patients with Head and Neck Cancer: A Comprehensive Review

et al. 2023

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The projected increase in life expectancy over the next few decades is expected to result in a rise in age-related diseases, including cancer. Head and neck cancer (HNC) is a worldwide health problem with high rates of morbidity and mortality. In this report, we have critically reviewed the literature reporting the management of older patients with HNC. Older adults are more prone to complications and toxicities secondary to HNC treatment, especially those patients who are frail or have comorbidities. Thus, this population should be screened prior to treatment for such predispositions to maximize medical management of comorbidities. Chronologic age itself is not a reason for choosing less intensive treatment for older HNC patients. Whenever possible, also older patients should be treated according to the best standard This article was written by members and invitees of the International Head and Neck Scientific Group (http:// www.IHNSG.com).

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Section: Prehabilitationmentioning

confidence: 99%

Management of Older Patients with Head and Neck Cancer: A Comprehensive Review

et al. 2023

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“…Prehabilitation adopts a proactive approach to enhance the patient’s health and physical condition prior to surgery, with the ultimate goal of fortifying their ability to endure the stress of the procedure and expedite their recovery thereafter. 12 …”

Section: Introductionmentioning

confidence: 99%

“… 11 Prehabilitation has proven effective in certain types of surgeries, particularly lung cancer and abdominal malignancy surgeries, with a multimodal prehabilitation approach often favored over a single preoperative lifestyle intervention. 12 , 14 - 16 However, there is a dearth of high-level evidence regarding the effectiveness of prehabilitation in CRC patients. The current evidence from randomized controlled trials (RCTs) is mixed, especially when considering studies from different regions.…”

Section: Introductionmentioning

confidence: 99%

Effect of Preoperative Lifestyle Management and Prehabilitation on Postoperative Capability of Colorectal Cancer Patients: A Systematic Review and Meta-Analysis

Zhang,

Hu,

Deng

et al. 2024

Integr Cancer Ther

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Background: The surgical intervention serves as the paramount and prevalent remedy for individuals afflicted with colorectal malignancies, with the significance of perioperative stewardship and convalescence being indisputable. Prehabilitation coupled with preoperative lifestyle modulation has demonstrated efficacy in patients subjected to certain classifications of abdominal procedures. However, the evidence pertaining to its impact on those battling colorectal cancer remains equivocal. Methods: A meta-analysis, grounded in pairwise contrast, of randomized controlled trials (RCTs) was orchestrated, coupled with a systematic review, to probe the efficacy of preoperative lifestyle modulation and prehabilitation on patients’ postoperative functionality and recuperation. An exhaustive exploration of 8 electronic databases and trial registries was undertaken to encompass all pertinent RCTs disseminated in English or Chinese from January 2012 through December 2022. Employing a random-effects model, we evaluated parameters such as the 6-minute walk test (6 MWT), complications, quality of life (QoL), aggregate and postoperative duration of hospitalization (tLHS and postLHS), and healthcare expenditure (HExp) for postoperative patients. Results: A total of 28 RCTs were incorporated into the systematic review and meta-analysis. Relative to conventional preoperative care, rehabilitation or preoperative lifestyle management was found to enhance postoperative 6MWT ( SMD 1.30, 95% CI 0.30 to 2.29) and diminish the complication rate ( OR 0.53, 95% CI 0.40 to 0.69). Nonetheless, no significant discrepancies were observed in QoL ( SMD 1.81, 95% CI −0.26 to 3.87), tLHS ( SMD −0.26, 95% CI −0.68 to 0.15), and postLHS ( SMD −1.46, 95% CI −3.12 to 0.20) between the groups. HExp could not be evaluated due to a lack of sufficient data for synthesis. Most pooled outcomes exhibited significant heterogeneity, urging a cautious interpretation. Subgroup analysis revealed that nutritional interventions could mitigate the incidence of complications, and preoperative exercise could improve tLHS and postLHS. A combined approach of physical, nutritional, and psychological intervention or prehabilitation proved superior to any single intervention in enhancing postoperative capabilities. Conclusion: This meta-analysis delineated the efficacy of preoperative interventions on postoperative capabilities in patients with colorectal cancer, thereby offering evidence for clinical practice. It was concluded that preoperative interventions are unequivocally beneficial for postoperative functional recovery and the reduction of complication rates in patients with colorectal cancer. Nonetheless, the acquisition of more high-level evidence is still necessitated to further ascertain the effectiveness of this strategy for other patient groups and to establish its best practices. The heterogeneity in the pooled outcomes underlines the need for future studies to be more uniform in their design and reporting, which would facilitate more robust and reliable meta-analyses.

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“…Other components, such as smoking cessation, preoperative treatment of anemia, or medication reconciliation are also integrated as part of these programs. It is expected that a multimodal approach has synergistic effects resulting in better overall outcomes compared to unimodal approaches [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Implementation of prehabilitation in colorectal cancer surgery: qualitative research on how to strengthen facilitators and overcome barriers

Heil¹,

Driessen²,

Argillander

et al. 2022

Support Care Cancer

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Purpose Prehabilitation is increasingly offered to patients with colorectal cancer (CRC) undergoing surgery as it could prevent complications and facilitate recovery. However, implementation of such a complex multidisciplinary intervention is challenging. This study aims to explore perspectives of professionals involved in prehabilitation to gain understanding of barriers or facilitators to its implementation and to identify strategies to successful operationalization of prehabilitation. Methods In this qualitative study, semi-structured interviews were performed with healthcare professionals involved in prehabilitation for patients with CRC. Prehabilitation was defined as a preoperative program with the aim of improving physical fitness and nutritional status. Parallel with data collection, open coding was applied to the transcribed interviews. The Ottawa Model of Research Use (OMRU) framework, a comprehensive interdisciplinary model guide to promote implementation of research findings into healthcare practice, was used to categorize obtained codes and structure the barriers and facilitators into relevant themes for change. Results Thirteen interviews were conducted. Important barriers were the conflicting scientific evidence on (cost-)effectiveness of prehabilitation, the current inability to offer a personalized prehabilitation program, the complex logistic organization of the program, and the unawareness of (the importance of) a prehabilitation program among healthcare professionals and patients. Relevant facilitators were availability of program coordinators, availability of physician leadership, and involving skeptical colleagues in the implementation process from the start. Conclusions Important barriers to prehabilitation implementation are mainly related to the intervention being complex, relatively unknown and only evaluated in a research setting. Therefore, physicians’ leadership is needed to transform care towards more integration of personalized prehabilitation programs. Implications for cancer survivors By strengthening prehabilitation programs and evidence of their efficacy using these recommendations, it should be possible to enhance both the pre- and postoperative quality of life for colorectal cancer patients during survivorship.

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A Narrative Review About Prehabilitation in Surgery: Current Situation and Future Perspectives

Cited by 7 publications

References 53 publications

Management of Older Patients with Head and Neck Cancer: A Comprehensive Review

Management of Older Patients with Head and Neck Cancer: A Comprehensive Review

Effect of Preoperative Lifestyle Management and Prehabilitation on Postoperative Capability of Colorectal Cancer Patients: A Systematic Review and Meta-Analysis

Implementation of prehabilitation in colorectal cancer surgery: qualitative research on how to strengthen facilitators and overcome barriers

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