Improved preoperative aerobic fitness following a home-based bimodal prehabilitation programme in high-risk patients scheduled for liver or pancreatic resection

Wijk, Laura van; Bongers, Bart C.; Berkel, Annefleur E M; Buis, Carlijn I.; Reudink, Muriël; Liem, Mike S L; Slooter, Gerrit D.; Meeteren, N.L.U. van; Klaase, Joost M.

doi:10.1093/bjs/znac230

Cited by 19 publications

(22 citation statements)

References 15 publications

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“…To limit barriers to participation and adherence, the exercise programme will be delivered as near to the patients’ homes as possible, to minimise travel time. This is a very important factor for patients with cancer according to previous studies 55 68–70. The availability of and close collaboration with the nationwide Onconet network of physical therapists, who are specifically educated to supervise patients with cancer, is an important advantage.…”

Section: Discussionmentioning

confidence: 99%

“…This is a very important factor for patients with cancer according to previous studies. 55 [68][69][70] The availability of and close collaboration with the nationwide Onconet network of physical therapists, who are specifically educated to supervise patients with cancer, is an important advantage. An additional benefit of this approach is that it will facilitate implementation if the intervention proves to be effective.…”

Section: Open Accessmentioning

confidence: 99%

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EffectiveNess of a multimodal preHAbilitation program in patieNts with bladder canCEr undergoing radical cystectomy: protocol of the ENHANCE multicentre randomised controlled trial

et al. 2023

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IntroductionRadical cystectomy (RC) is the standard treatment for patients with non-metastatic muscle-invasive bladder cancer, as well as for patients with therapy refractory high-risk non-muscle invasive bladder cancer. However, 50–65% of patients undergoing RC experience perioperative complications. The risk, severity and impact of these complications is associated with a patient’s preoperative cardiorespiratory fitness, nutritional and smoking status and presence of anxiety and depression. There is emerging evidence supporting multimodal prehabilitation as a strategy to reduce the risk of complications and improve functional recovery after major cancer surgery. However, for bladder cancer the evidence is still limited. The aim of this study is to investigate the superiority of a multimodal prehabilitation programme versus standard-of-care in terms of reducing perioperative complications in patients with bladder cancer undergoing RC.Methods and analysisThis multicentre, open label, prospective, randomised controlled trial, will include 154 patients with bladder cancer undergoing RC. Patients are recruited from eight hospitals in The Netherlands and will be randomly (1:1) allocated to the intervention group receiving a structured multimodal prehabilitation programme of approximately 3–6 weeks, or to the control group receiving standard-of-care. The primary outcome is the proportion of patients who develop one or more grade ≥2 complications (according to the Clavien-Dindo classification) within 90 days of surgery. Secondary outcomes include cardiorespiratory fitness, length of hospital stay, health-related quality of life, tumour tissue biomarkers of hypoxia, immune cell infiltration and cost-effectiveness. Data collection will take place at baseline, before surgery and 4 and 12 weeks after surgery.Ethics and disseminationEthical approval for this study was granted by the Medical Ethics Committee NedMec (Amsterdam, The Netherlands) under reference number 22–595/NL78792.031.22. Results of the study will be published in international peer-reviewed journals.Trial registration numberNCT05480735.

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Section: Discussionmentioning

confidence: 99%

Section: Open Accessmentioning

confidence: 99%

EffectiveNess of a multimodal preHAbilitation program in patieNts with bladder canCEr undergoing radical cystectomy: protocol of the ENHANCE multicentre randomised controlled trial

et al. 2023

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“…Frail patients can undergo a prehabilitation program to increase their general fitness and anerobic threshold while awaiting the surgery. This could decrease the prevalence of post-operative complications [ 33 ]. Moreover, the surgical technique can be adjusted, for example, an isolated roux loop for the pancreatic anastomosis can be used separating the pancreatojejunostomy and hepatojejunostomy [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…This could decrease the prevalence of post-operative complications [ 33 ]. Moreover, the surgical technique can be adjusted, for example, an isolated roux loop for the pancreatic anastomosis can be used separating the pancreatojejunostomy and hepatojejunostomy [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

External Validation of a Risk Model for Severe Complications following Pancreatoduodenectomy Based on Three Preoperative Variables

Alhulaili

Pleijhuis

Nijkamp

et al. 2022

Cancers

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Background: Pancreatoduodenectomy (PD) is the only cure for periampullary and pancreatic cancer. It has morbidity rates of 40–60%, with severe complications in 30%. Prediction models to predict complications are crucial. A risk model for severe complications was developed by Schroder et al. based on BMI, ASA classification and Hounsfield Units of the pancreatic body on the preoperative CT scan. These variables were independent predictors for severe complications upon internal validation. Our aim was to externally validate this model using an independent cohort of patients. Methods: A retrospective analysis was performed on 318 patients who underwent PD at our institution from 2013 to 2021. The outcome of interest was severe complications Clavien–Dindo ≥ IIIa. Model calibration, discrimination and performance were assessed. Results: A total of 308 patients were included. Patients with incomplete data were excluded. A total of 89 (28.9%) patients had severe complications. The externally validated model achieved: C-index = 0.67 (95% CI: 0.60–0.73), regression coefficient = 0.37, intercept = 0.13, Brier score = 0.25. Conclusions: The performance ability, discriminative power, and calibration of this model were acceptable. Our risk calculator can help surgeons identify high-risk patients for post-operative complications to improve shared decision-making and tailor perioperative management.

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“…The training progression should be objectively measured by weekly or biweekly repetition of the SRT so to monitor changes in cardiorespiratory fitness, while the program can be adjusted accordingly to maintain a sufficient training stimulus. This partially supervised preoperative SRT‐based HIIT program was deemed feasible (82.5% adherence rate, 57.6% full completion rate, 11.5% dropout rate, no serious adverse events, high patient satisfaction) and effective (improvements of 17.2% and 17.8% in VO 2peak and oxygen uptake at the ventilatory anaerobic threshold, respectively) for preoperatively increasing the cardiorespiratory fitness of high‐risk patients who are scheduled to undergo hepatopancreatobiliary surgery ( n = 26) 23 . This program is currently being investigated to determine its usefulness for other populations requiring major surgery.…”

Section: Solutionmentioning

confidence: 99%

Steep ramp test protocol for preoperative risk assessment and short‐term high‐intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology

Improved preoperative aerobic fitness following a home-based bimodal prehabilitation programme in high-risk patients scheduled for liver or pancreatic resection

Cited by 19 publications

References 15 publications

EffectiveNess of a multimodal preHAbilitation program in patieNts with bladder canCEr undergoing radical cystectomy: protocol of the ENHANCE multicentre randomised controlled trial

EffectiveNess of a multimodal preHAbilitation program in patieNts with bladder canCEr undergoing radical cystectomy: protocol of the ENHANCE multicentre randomised controlled trial

External Validation of a Risk Model for Severe Complications following Pancreatoduodenectomy Based on Three Preoperative Variables

Steep ramp test protocol for preoperative risk assessment and short‐term high‐intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology

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