Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study

Li, Chao; Carli, Francesco; Lee, Lawrence; Charlebois, Patrick; Stein, Barry; Liberman, Alexander; Kaneva, Pepa; Augustin, Berson; Wongyingsinn, Mingkwan; Gamsa, Ann; Kim, Do Jun; Vassiliou, Melina C.; Feldman, Liane S.

doi:10.1007/s00464-012-2560-5

Cited by 482 publications

(446 citation statements)

References 36 publications

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“…A pilot study [17] followed by a RCT [18], using a multimodal prehabilitation program composed of moderate intensity physical exercise, complemented by nutritional counseling, protein supplementation and anxiety reduction strategies, was conducted in 164 patients undergoing colorectal resection, and more than 80% of patients were able to return to preoperative functional capacity by eight weeks, compared with 40% of a control group.…”

Section: Resultsmentioning

confidence: 99%

Promoting a culture of prehabilitation for the surgical cancer patient

2017

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Background: Traditional rehabilitative approaches to perioperative cancer care have focused on the postoperative period to facilitate the return to presurgical baseline conditions. However, there is some realization that the preoperative period can be a very effective time for intervention as the patients are more amenable to target their physiological condition to prepare to overcome the metabolic cost of the surgical stress. Methods: We undertook a narrative review of the current literature on surgical prehabilitation and discussed the current evidence of preoperative interventions before cancer surgery in order to increase physiological reserve before surgery and accelerate postoperative recovery. Results: Published data indicate the positive impact of prehabilitation on postoperative functional capacity and return to daily activities. However, the current evidence on the impact on short-and long-term clinical outcome is limited, and more research needs to be conducted. Conclusion: Preliminary findings indicate that a group of interventions such as exercise, nutrition and anxiety reduction in the preoperative period can complement the enhanced recovery program and facilitate the return to baseline activities of daily living. It is not clear at this stage whether the preoperative increase in functional capacity mitigates the burden of postoperative morbidities and subsequent cancer therapies. Therefore, more research is warranted.

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Section: Resultsmentioning

confidence: 99%

Promoting a culture of prehabilitation for the surgical cancer patient

2017

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“…Integrated care delivery models, such as enhanced recovery after surgery programmes, have already confirmed the possibility of significantly improving clinical and functional outcomes in elderly and high‐risk patients60, 61, 62. In this situation, despite limited evidence, prehabilitation programmes, including preoperative optimization of coexisting chronic disease therapy, nutritional status, physical function and physiological support63, 64, 65, may represent a more comprehensive and effective opportunity.…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

et al. 2017

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BackgroundFrailty is associated with poor prognosis, but the multitude of definitions and scales of assessment makes the impact on outcomes difficult to assess. The aim of this study was to quantify the effect of frailty on postoperative morbidity and mortality, and long‐term mortality after major abdominal surgery, and to evaluate the performance of different frailty metrics.MethodsAn extended literature search was performed to retrieve all original articles investigating whether frailty could affect outcomes after elective major abdominal surgery in adult populations. All possible definitions of frailty were considered. A random‐effects meta‐analysis was carried out for all outcomes of interest. For postoperative morbidity and mortality, overall effect sizes were estimated as odds ratios (OR), whereas the hazard ratio (HR) was calculated for long‐term mortality. The potential effect of the number of domains of the frailty indices was explored through meta‐regression at moderator analysis.ResultsA total of 35 studies with 1 153 684 patients were analysed. Frailty was associated with a significantly increased risk of postoperative major morbidity (OR 2·56, 95 per cent c.i. 2·08 to 3·16), short‐term mortality (OR 5·77, 4·41 to 7·55) and long‐term mortality (HR 2·71, 1·63 to 4·49). All domains were significantly associated with the occurrence of postoperative major morbidity, with ORs ranging from 1·09 (1·00 to 1·18) for co‐morbidity to 2·52 (1·32 to 4·80) for sarcopenia. No moderator effect was observed according to the number of frailty components.ConclusionRegardless of the definition and combination of domains, frailty was significantly associated with an increased risk of postoperative morbidity and mortality after major abdominal surgery.

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“…In a recent study, only 40% of patients having had laparoscopic colectomy returned to their preoperative functional walking capacity at eight weeks following surgery. 41 Loss of functional capacity can occur even in patients undergoing day surgery. In a study of patients who underwent laparoscopic cholecystectomy, a procedure whereby patients are usually discharged home a few hours after surgery, 30% had not returned to baseline function at four weeks after surgery.…”

Section: Painmentioning

confidence: 99%

“…A pilot study followed by a recent randomized controlled trial using multimodal interventions in the three to four weeks prior to colorectal surgery for cancer showed significant improvement in functional capacity and mental health in over 80% of patients two months after surgery. 41,50 Of course, this field of research is in its relative infancy, and there is a need for a better understanding of the mechanisms initiated during prehabilitation that result in modulating functional capacity.…”

Section: Preoperative Optimizationmentioning

confidence: 99%

Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response

Carli

2014

Can J Anesth/J Can Anesth

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162

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Purpose Enhanced Recovery After Surgery (ERAS) programs have increasingly attracted the attention of clinicians who are intent on minimizing postoperative morbidity, decreasing variability in surgical care, and containing hospital costs. The purpose of this review is to discuss the relevant pathophysiology of the surgical stress response and its associated mechanisms that regulate important metabolic changes.

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Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study

Abstract: In this pilot study, a 1-month trimodal prehabilitation program improved postoperative functional recovery. A randomized trial is ongoing (NCT01356264).

Cited by 482 publications

References 36 publications

Promoting a culture of prehabilitation for the surgical cancer patient

Promoting a culture of prehabilitation for the surgical cancer patient

Systematic review and meta-analysis of frailty as a predictor of morbidity and mortality after major abdominal surgery

Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response

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