Can we "prehabilitate" pancreatic cancer patients prior to surgery?A critical appraisal of the literature.

exercise nutrition outcomes pancreaticoduodenectomy quality

Journal

Clinical nutrition ESPEN
ISSN: 2405-4577
Titre abrégé: Clin Nutr ESPEN
Pays: England
ID NLM: 101654592

Informations de publication

Date de publication:
21 Aug 2024
Historique:
received: 02 07 2024
revised: 04 08 2024
accepted: 13 08 2024
medline: 24 8 2024
pubmed: 24 8 2024
entrez: 23 8 2024
Statut: aheadofprint

Résumé

Enhancing a patient's functional capacity to withstand the surgical stress by means of multimodal (combined exercise, nutrition and psychological interventions) prehabilitation may potentially lead to improved outcomes in pancreatic cancer surgery. A systematic review was undertaken searching PubMed, Google Scholar and Cochrane Library databases, exploring the impact of prehabilitation in pancreatic surgery. Outcomes of interest were adherence to the prehabilitation, functional capacity, overall complications and post-operative length of stay. Pooled analysis was performed using a random-effects model. Twelve studies comprising of 1497 patients were included in the review. Most of the studies seem to lack a multimodal approach. Less than 50 % of the studies reported adherence, which ranged between 27 to 100 %. Functional capacity, in terms of 6-minute walk test, showed improvement with prehabilitation. Among the post-operative outcomes, prehabilitation was associated with significant improvement in pulmonary complications (2.4 % versus 6.7 %, RR 0.36, CI 0.17-0.74, p= 0.01, I Larger studies with multimodal prehabilitation approaches may demonstrate more consistent and clinically meaningful benefits, which would lead to a firm appreciation of its role the management of pancreatic cancer patients undergoing surgery.

Sections du résumé

BACKGROUND BACKGROUND
Enhancing a patient's functional capacity to withstand the surgical stress by means of multimodal (combined exercise, nutrition and psychological interventions) prehabilitation may potentially lead to improved outcomes in pancreatic cancer surgery.
METHODOLOGY METHODS
A systematic review was undertaken searching PubMed, Google Scholar and Cochrane Library databases, exploring the impact of prehabilitation in pancreatic surgery. Outcomes of interest were adherence to the prehabilitation, functional capacity, overall complications and post-operative length of stay. Pooled analysis was performed using a random-effects model.
RESULTS RESULTS
Twelve studies comprising of 1497 patients were included in the review. Most of the studies seem to lack a multimodal approach. Less than 50 % of the studies reported adherence, which ranged between 27 to 100 %. Functional capacity, in terms of 6-minute walk test, showed improvement with prehabilitation. Among the post-operative outcomes, prehabilitation was associated with significant improvement in pulmonary complications (2.4 % versus 6.7 %, RR 0.36, CI 0.17-0.74, p= 0.01, I
CONCLUSIONS CONCLUSIONS
Larger studies with multimodal prehabilitation approaches may demonstrate more consistent and clinically meaningful benefits, which would lead to a firm appreciation of its role the management of pancreatic cancer patients undergoing surgery.

Identifiants

DOI: 10.1016/j.clnesp.2024.08.003 PMID: 39178986
pubmed: 39178986
pii: S2405-4577(24)01274-9
doi: 10.1016/j.clnesp.2024.08.003
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Auteurs

Mina Refaat (M)

Division of Surgery and Perioperative Medicine, Flinders Medical Center, Bedford Park, Adelaide, South Australia - Australia.

Shreeyash Modak (S)

Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.

Chidananda Harivelam (C)

Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.

Shahid Ullah (S)

College of Medicine and Public Health, Flinders University, Adelaide, South Australia - Australia.

Katia Ferrar (K)

College of Medicine and Public Health, Flinders University, Adelaide, South Australia - Australia.

Sunil Pandya (S)

Department of Anesthesiology, Asian Institute of Gastroenterology, Hyderabad, India.

Pradeep Rebala (P)

Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.

G V Rao (GV)

Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.

Hans D de Boer (HD)

Department of Anesthesiology, Pain Medicine and Procedural Sedation and Analgesia, Martini General Hospital Groningen, Groningen, The Netherlands.

Savio George Barreto (SG)

Division of Surgery and Perioperative Medicine, Flinders Medical Center, Bedford Park, Adelaide, South Australia - Australia; College of Medicine and Public Health, Flinders University, Adelaide, South Australia - Australia.

Monish Karunakaran (M)

Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India; College of Medicine and Public Health, Flinders University, Adelaide, South Australia - Australia. Electronic address: monish3682@gmail.com.

Classifications MeSH