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 19 February 2018

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News

Prehabilitation programs as a bundle of care in GI cancer surgery

A study in the latest issue of the Diseases of the Colon & Rectum examines multimodal prehabilitation programs as a bundle of care in gastrointestinal cancer surgery.

News image

Prehabilitation reflects a proactive process of preoperative optimization undertaken between cancer diagnosis and definitive surgical treatment, with the intent of improving physiological capacity to withstand the major insult of surgery.

Prehabilitation before GI cancer surgery is currently not widely adopted, and most research has focused on unimodal interventions such as exercise therapy, nutritional supplementation, and hematinic optimization.

Dr Vladimir Bolshinsky and colleagues reviewed the existing literature to investigate the impact of multimodal prehabilitation programs as a “bundle of care.”

The researchers performed a systematic literature utilizing Medline, PubMed, Embase, Cinahl, Cochrane, and Google Scholar databases.

Trials exploring prehabilitation with unimodal interventions included impact of exercise therapy
Diseases of the Colon & Rectum

The quality of studies was assessed by using the Cochrane tool for assessing risk of bias, and the Newcastle-Ottawa Quality Assessment scale (cohort studies).

Studies were chosen that involved pre-operative optimization of patients before GI cancer surgery.

The team's primary outcome measured was the impact of prehabilitation programs on preoperative fitness and postoperative outcomes.

Of the 544 studies identified, the team noted that 20 were included in the qualitative analysis.

The researchers identified 2 trials that investigated the impact of multimodal prehabilitation.

Trials exploring prehabilitation with unimodal interventions included impact of exercise therapy, impact of preoperative iron replacement, nutritional optimization, and impact of preoperative smoking cessation.

The team noted that compliance within the identified studies was variable.

Dr Bolshinsky's team concludes, "Although small studies are supportive of multimodal interventions, there are insufficient data to make a conclusion about the integration of prehabilitation in GI cancer surgery as a bundle of care."

"Larger, prospective trials, utilizing uniform objective risk stratification and structured interventions, with predefined clinical and health economic end points, are required before definitive value can be assigned to prehabilitation programs."

Dis Colon Rectum 2018: 61(1): 124–138
16 January 2018

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