Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program

Abstract

Patients undergoing major surgery are predisposed to a decrease in functional capacity as a response to surgical stress that can delay post-operative recovery. A prehabilitation program consists of patient preparation strategies before surgery, and include pre-operative measures to improve functional capacity and enhance post-operative recovery. Multimodal prehabilitation may include exercise, nutritional counseling, psychological support, and optimization of underlying medical conditions, as well as cessation of unfavorable health behaviors such as smoking and drinking. Currently, there are no standardized guidelines for prehabilitation, and the existent studies are heterogeneous; however, multimodal approaches are likely to have a greater impact on functional outcomes than single management programs. We have reviewed the literature on prehabilitation in general, and in gynecologic surgery in particular, to identify tools to establish an optimal prehabilitation program within an Enhanced Recovery After Surgery (ERAS) protocol for gynecologic oncology patients. We suggest a safe, reproducible, functional, and easy-to-apply multimodal prehabilitation program for gynecologic oncology practice based on patient-tailored pre-operative medical optimization, physical training, nutritional counseling, and psychological support. The analysis of the prehabilitation program implementation in an ERAS protocol should undergo further research in order to test the efficacy on surgical outcome and recovery after surgery.

Prehabilitation for medically frail patients undergoing surgery for epithelial ovarian cancer: a cost-effectiveness analysis

“…However, this analysis also found a lack of benefit in longer programs [ 38 ]. This concern about program duration was addressed by Miralpeix et al [ 39 ], who established that interventions for EOC patients intended for primary cytoreduction begin at suspected diagnosis, during outpatient preoperative evaluation.…”

“…It is likely that differences in study design, patient selection, and small sample sizes may contribute to these differences; these factors also represent the challenge with extrapolating and establishing an optimal prehabilitation regimen more broadly. Miralpeix et al [ 39 ] utilized published prehabilitation regimens to propose a multimodal protocol for gynecologic oncology patients ranging from 2–4 weeks in duration, incorporating medical optimization with exercise and nutrition interventions. This publication provides a starting place for well-designed, prospective trials in gynecologic oncology, which are necessary to answer these questions.…”

Impact of prehabilitation during neoadjuvant chemotherapy and interval cytoreductive surgery on ovarian cancer patients: a pilot study

“…The prehabilitation group received a structured intervention including physical exercise recommendations, nutritional counseling, and psychological support. This program was extensively described in a previous publication [ 15 ]. Briefly, all patients included in the prehabilitation program received recommendations for daily exercise practice, nutritional counseling based on homemade recipes of protein supplementation and psychological support, and a preoperative carbohydrate loading and an inspiratory threshold-loading device in our consultation.…”

Enhanced recovery protocols after pelvic floor reconstructive surgery

“…Patient status optimization of comorbid conditions, such as diabetes mellitus, anemia, and hypertension, were also associated with enhanced recovery outcomes, while early recovery after surgery has been reported with psychological and physical intervenvolume 20, issue 4, oCToBeR -DeCemBeR 2021 tions, such as exercise and nutritional supplementation prior to surgery 14,15 .…”