Multimodal prerehabilitation for elderly patients with sarcopenia in colorectal surgery

Abstract

Sarcopenia, which is characterized by progressive and generalized loss of skeletal muscle mass and strength, has been well described to be associated with numerous poor postoperative outcomes, such as increased perioperative mortality, postoperative sepsis, prolonged length of stay, increased cost of care, decreased functional outcome, and poorer oncological outcomes in cancer surgery. Multimodal prehabilitation, as a concept that involves boosting and optimizing the preoperative condition of a patient prior to the upcoming stressors of a surgical procedure, has the purported benefits of reversing the effects of sarcopenia, shortening hospitalization, improving the rate of return to bowel activity, reducing the costs of hospitalization, and improving quality of life. This review aims to present the current literature surrounding the concept of sarcopenia, its implications pertaining to colorectal cancer and surgery, a summary of studied multimodal prehabilitation interventions, and potential future advances in the management of sarcopenia.

Prognostic significance of osteosarcopenia in patients with stage IV gastric cancer undergoing conversion surgery

“…Currently, drug therapy, exercise, and nutritional programs play important roles in improving sarcopenia and osteopenia in patients with malignancies [24][25][26]. Since vitamin D de ciency is a signi cant risk factor for low BMD, preoperative drug support, including calcium intake and vitamin D supplementation, may help prevent osteopenia [27].…”

Current fistula management

“…Nutritional prehabilitation is especially significant in this population that is at such high risk of malnutrition. Sarcopenia has been well described to be associated with increased perioperative mortality, decreased functional outcome, prolonged length of hospital stays, and increased rates of postoperative sepsis [14]. Overall maintenance of nutritional status in ECF is an ongoing issue in these patients and may be difficult to optimize.…”

Differences in Functional Capacity between Oncologic and Non-Oncologic Populations: Reference Values

“…Furthermore, in patients scheduled for oncologic surgery, sarcopenia has been associated with greater complications in postoperative follow-up along with longer hospitalization days [27], loss of muscle mass and function [28,29], lower tolerance to chemotherapy and radiotherapy [30], and even mortality [31]. Likewise, several studies have shown the efficacy of strength exercise during oncological treatment [7,23,24,32,33], as it can increase muscle mass levels and release natural killer cells [34].…”