Carli Francesco, Gillis Chelsia, Scheede-Bergdahl Celena
a Department of Anesthesia , McGill University , Montreal , QC , Canada.
b Cumming School of Medicine , University of Calgary , AB , Canada.
Acta Oncol. 2017 Feb;56(2):128-133. doi: 10.1080/0284186X.2016.1266081. Epub 2017 Jan 9.
Traditional rehabilitative approaches to perioperative cancer care have focused on the postoperative period to facilitate the return to presurgical baseline conditions. However, there is some realization that the preoperative period can be a very effective time for intervention as the patients are more amenable to target their physiological condition to prepare to overcome the metabolic cost of the surgical stress.
We undertook a narrative review of the current literature on surgical prehabilitation and discussed the current evidence of preoperative interventions before cancer surgery in order to increase physiological reserve before surgery and accelerate postoperative recovery.
Published data indicate the positive impact of prehabilitation on postoperative functional capacity and return to daily activities. However, the current evidence on the impact on short- and long-term clinical outcome is limited, and more research needs to be conducted.
Preliminary findings indicate that a group of interventions such as exercise, nutrition and anxiety reduction in the preoperative period can complement the enhanced recovery program and facilitate the return to baseline activities of daily living. It is not clear at this stage whether the preoperative increase in functional capacity mitigates the burden of postoperative morbidities and subsequent cancer therapies. Therefore, more research is warranted.
围手术期癌症护理的传统康复方法侧重于术后阶段，以促进患者恢复到术前的基线状态。然而，人们逐渐认识到，术前阶段可能是进行干预的非常有效的时期，因为患者更愿意针对自身生理状况进行调整，为克服手术应激的代谢成本做好准备。
我们对当前关于手术前康复的文献进行了叙述性综述，并讨论了癌症手术前术前干预的现有证据，以便在手术前增加生理储备并加速术后恢复。
已发表的数据表明，术前康复对术后功能能力和恢复日常活动有积极影响。然而，目前关于其对短期和长期临床结局影响的证据有限，需要开展更多研究。
初步研究结果表明，术前进行的一系列干预措施，如运动、营养补充和减轻焦虑等，可以补充强化康复计划，并促进患者恢复到日常生活的基线活动水平。目前尚不清楚术前功能能力的提高是否能减轻术后并发症以及后续癌症治疗的负担。因此，有必要开展更多研究。
