Clinical Benefit of Preoperative Exercise and Nutritional Therapy for Patients Undergoing Hepato-Pancreato-Biliary Surgeries for Malignancy

Factors Associated with Treatment and Survival of Early Stage Pancreatic Cancer in the Era of Modern Chemotherapy: An Analysis of the National Cancer Database

“…This has been confirmed in several other studies using older data from within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2011), 2 as well as the NCDB (2003-2012), 6 NCDB 2004-2015, 7 SEER 1992-2002, 8 and institutional data (2004-2013) from a high-volume tertiary center. 9 The management of pancreatic cancer has evolved over the past several years, with incorporation of neoadjuvant therapy, 4,[10][11][12] prehabilitation, 13 and minimally invasive approaches, [14][15][16][17][18] and these data may not be applicable to the modern era.…”

Study protocol of a single-arm pre-post study to assess the preliminary effectiveness and feasibility of a home-based bimodal prehabilitation program on preoperative aerobic fitness in high-risk patients scheduled for liver or pancreatic resection

“…9 Nakajima et al recently reported that an unsupervised home-based exercise prehabilitation program improved physical fitness (median 6-minute walk test distance improved from 530 to 554 m; p<0.001) before hepatopancreatobiliary surgery in the intervention group, with merely a statistically significant reduction in postoperative length of stay compared to the control group. 10 In general, currently described home-based prehabilitation programs were not supervised and not targeted at high-risk patients, 9 probably limiting therapy adherence and effectiveness.…”

“…A test will be considered to be at or near the maximal level when participants show clinical signs of intense effort (e.g., unsteady biking, sweating, clear unwillingness to continue exercising despite strong encouragement), are unable to maintain the required pedalling speed, and when at least one of the following criteria is met: an HR at peak exercise (HR peak ) >95% of predicted (predicted HR [beats/min] = 210 -(0.8 × age [years])) or an RER at peak exercise (RER peak ) >1. 10. Absolute values at peak exercise will be calculated as the average value over the last 30 seconds prior to termination of the test.…”

“…11 In a recent study of Barberan-Garcia et al in high-risk patients who underwent elective major abdominal surgery, exercise prehabilitation not only improved preoperative aerobic fitness, but also resulted in a 51% reduction in postoperative complications compared to the usual care group. [8][9][10][11][12] Most preoperative training programs were carried out under supervision in an outpatient clinic; however, a personalized exercise program in a home-based setting might enhance the participation rate, motivation, and adherence of (high-risk) patients, and has proven to be the preferred method for a prehabilitation program. 11,13,14 Although several studies investigated the effects of exercise prehabilitation in liver and/or pancreatic resection and reported positive effects on physical fitness and postoperative morbidity, there is limited evidence addressing the feasibility and effectiveness of supervised home-based prehabilitation in these populations.…”

Prehabilitation in elderly patients scheduled for liver resection and protocol for Recovery Of Surgery in Elderly

“…In a propensity-score matched study including 76 patients undergoing major hepato-pancreatico-biliary Figure 1. Age related physiological changes by system [2] surgery, Nakajima et al [20] reported improvements in serum albumin levels and reduction in hospital stay length but no difference in complication rates. Low serum albumin is associated with increased morbidity in elective and emergency procedures [21] .…”