Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands.
Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands.
Colorectal Dis. 2016 Aug;18(8):O267-77. doi: 10.1111/codi.13429.
Prehabilitation, defined as enhancement of the preoperative condition of a patient, is a possible strategy for improving postoperative outcome. Lack of muscle strength and poor physical condition, increasingly prevalent in older patients, are risk factors for postoperative complications. Eighty-five per cent of patients with colorectal cancer are aged over 60 years. Since surgery is the cornerstone of their treatment, this review systemically examined the literature on the effect of physical prehabilitation in older patients undergoing colorectal surgery.
Trials and case-control studies investigating the effect of physical prehabilitation in patients over 60 years undergoing colorectal surgery were retrieved from MEDLINE, EMBASE, CINAHL and the Cochrane library. Patient characteristics, the type of intervention and outcome measurements were recorded. The risk of bias and heterogeneity was assessed.
Five studies including 353 patients were identified. They were small, containing an average of 77 patients and were of moderate methodological quality. Compliance rates of the prehabilitation programme varied from 16 to 97%. None of the studies could identify a significant reduction of postoperative complications or length of hospital stay. Four studies showed physical improvement (walking distance, respiratory endurance) in the prehabilitation group. Clinical heterogeneity precluded a meta-analysis.
Prehabilitation is a possible means of enhancing the physical condition of patients preoperatively. The quality of studies in older patients undergoing colorectal surgery is poor, despite the increase in elderly people with colorectal cancer. Defining specific patient groups at risk and standardizing the outcome are essential for improving the results of treatment.
术前患者身体状况的改善即预康复，这可能是改善术后结果的一种策略。肌肉力量不足和身体状况不佳在老年患者中越来越常见，是术后并发症的危险因素。85%的结直肠癌患者年龄在 60 岁以上。由于手术是其治疗的基石，因此，本文系统地综述了关于老年结直肠手术患者进行身体预康复的效果的文献。
从 MEDLINE、EMBASE、CINAHL 和 Cochrane 图书馆中检索了调查 60 岁以上接受结直肠手术的患者进行身体预康复效果的试验和病例对照研究。记录了患者特征、干预类型和结果测量。评估了偏倚风险和异质性。
共确定了 5 项研究，包括 353 名患者。这些研究规模较小，平均纳入 77 名患者，方法学质量中等。预康复方案的依从率从 16%到 97%不等。没有一项研究能确定术后并发症或住院时间的显著减少。四项研究显示预康复组的身体状况（步行距离、呼吸耐力）有所改善。由于临床异质性，无法进行荟萃分析。
预康复是一种增强患者术前身体状况的可能方法。尽管结直肠癌老年患者人数不断增加，但接受结直肠手术的老年患者的研究质量较差。明确特定的高危患者群体并标准化结果对于改善治疗效果至关重要。
