Prehabilitation for Upper Gastrointestinal Tract Cancer Surgery

Официальное название

The Effects of Multimodal Prehabilitation on Post-operative Recovery in Patients Undergoing Surgery for Upper Gastrointestinal Tract Cancer in Taiwan

Обзор

Patients receiving surgery of upper gastrointestinal tract are often elderly, frail, malnourished, with poor functional reserve. They are associated with poor post-operative outcomes. This multimodal treatment is associated with considerable morbidity and decline of patients' functional capacity due to sarcopenia and malnutrition. The poor outcomes can lead to a prolonged delayed recovery, hospital stay, and disability. The post-operative morbidity, especially cardiopulmonary complications, remains substantial. Prehabilitation before surgery can improve the functional capacity of patients to better withstand the stress of surgery. In this perspective, prehabilitation has gained increasing popularity as it consists of various interventions that aim to optimize patient's preoperative condition. The rehabilitation programmes varies considerably. To maximise the benefits that can be accrued in the pre-operative period, prehabilitation programmes should be multimodal, including exercise and nutritional support. Increasing the maximal aerobic capacity by training before surgery, improves patients' functional capacity and should allow patients to better withstand the postoperative stress response. Prehabilitation has been trialled in a range of surgical specialities, including colorectal, breast, hepatobiliary, bariatric, urological, thoracic, and orthopaedic surgery. In major abdominal surgery, multiple studies have indicated that prehabilitation improved preoperative functional capacity and postoperative outcomes. There is a large body of evidence for prehabilitation in patients undergoing intra-abdominal surgery, with studies reporting improvements in pre-operative cardiopulmonary fitness, and reductions in post-operative complications. The data on prehabilitation after surgery for upper gastrointestinal tract are scarce and ambiguous and these studies often lacked a multimodal approach. The evidence of prehabilitation in Taiwan is scarce also. Surgery for upper gastrointestinal tract has a high morbidity and is associated with a prolonged recovery so there is significant potential to improve outcomes in this high-risk population. However, there are few studies of prehabilitation in surgery for upper gastrointestinal tract. Hence, this study aimed to investigate the effect of a multimodal personalised, prehabilitation program on postoperative recovery and morbidity in patients undergoing surgery for upper gastrointestinal tract.

Вмешательства

• Другое Prehabilitation
  A personalised, home-based exercise programme was prescribed by a physical therapist. In keeping with WHO guidelines, patients were prescribed a minimum of 600 MET minutes week-1, which equates to 150 min of moderate intensity activity, with the aim of increasing this to 1200 MET minutes week-1 (300 min of moderate intensity activity). Patients were prescribed a mixture of aerobic and strength exercises, each with a defined frequency, intensity, and duration. Patients received training on how to

Первичные конечные точки

• Length of hospital stay [Срок оценки: From enrollment to the end of treatment at 8 weeks]
• 30-day readmission rate [Срок оценки: From enrollment to the end of treatment at 12 weeks]
• Pulmonary complications [Срок оценки: From enrollment to the end of treatment at 8 weeks]
• Anastomotic leakage rate [Срок оценки: From enrollment to the end of treatment at 8 weeks]
• Severity (Clavien-Dindo) of complications [Срок оценки: From enrollment to the end of treatment at 8 weeks]

Критерии участия

Критерии включения

• aged ≥ 18 years
• with a diagnosis of potentially resectable upper gastrointestinal tract cancer

Критерии исключения

• inability to give informed consent
• non resectable disease
• patients who declined surgery

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Не применимо

Модель

Одна группа

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Тайвань · 1 центр

• Taichung Tzu Chi Hospital — Taichung

Публикации

• Dewberry LC, Wingrove LJ, Marsh MD, Glode AE, Schefter TE, Leong S, Purcell WT, McCarter MD. Pilot Prehabilitation Program for Patients With Esophageal Cancer During Neoadjuvant Therapy and Surgery. J Surg Res. 2019 Mar;235:66-72. doi: 10.1016/j.jss.2018.09.060. Epub 2018 Oct 23. PMID 30691852
• Akkerman RD, Haverkamp L, van Rossum PS, van Hillegersberg R, Ruurda JP. Long-term quality of life after oesophagectomy with gastric conduit interposition for cancer. Eur J Cancer. 2015 Aug;51(12):1538-45. doi: 10.1016/j.ejca.2015.05.006. Epub 2015 May 29. PMID 26031552
• Low DE, Kuppusamy MK, Alderson D, Cecconello I, Chang AC, Darling G, Davies A, D'Journo XB, Gisbertz SS, Griffin SM, Hardwick R, Hoelscher A, Hofstetter W, Jobe B, Kitagawa Y, Law S, Mariette C, Maynard N, Morse CR, Nafteux P, Pera M, Pramesh CS, Puig S, Reynolds JV, Schroeder W, Smithers M, Wijnhoven BPL. Benchmarking Complications Associated with Esophagectomy. Ann Surg. 2019 Feb;269(2):291-298. PMID 29206677
• Bolger JC, Loughney L, Tully R, Cunningham M, Keogh S, McCaffrey N, Hickey W, Robb WB. Perioperative prehabilitation and rehabilitation in esophagogastric malignancies: a systematic review. Dis Esophagus. 2019 Nov 13;32(9):doz058. doi: 10.1093/dote/doz058. PMID 31206582
• Hughes MJ, Hackney RJ, Lamb PJ, Wigmore SJ, Christopher Deans DA, Skipworth RJE. Prehabilitation Before Major Abdominal Surgery: A Systematic Review and Meta-analysis. World J Surg. 2019 Jul;43(7):1661-1668. doi: 10.1007/s00268-019-04950-y. PMID 30788536
• Minnella EM, Bousquet-Dion G, Awasthi R, Scheede-Bergdahl C, Carli F. Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience. Acta Oncol. 2017 Feb;56(2):295-300. doi: 10.1080/0284186X.2016.1268268. Epub 2017 Jan 12. PMID 28079430
• West MA, Loughney L, Lythgoe D, Barben CP, Sripadam R, Kemp GJ, Grocott MP, Jack S. Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth. 2015 Feb;114(2):244-51. doi: 10.1093/bja/aeu318. Epub 2014 Oct 1. PMID 25274049
• Hijazi Y, Gondal U, Aziz O. A systematic review of prehabilitation programs in abdominal cancer surgery. Int J Surg. 2017 Mar;39:156-162. doi: 10.1016/j.ijsu.2017.01.111. Epub 2017 Feb 2. PMID 28161527

Идентификаторы

NCT: NCT07713888 · TTCH2026

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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