Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan.
Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8550, Japan.
Ann Surg Oncol. 2019 Jan;26(1):264-272. doi: 10.1245/s10434-018-6943-2. Epub 2018 Oct 26.
The impact of prehabilitation on physical fitness and postoperative course after hepato-pancreato-biliary (HPB) surgeries for malignancy is unknown. The current study aimed to investigate the effect of preoperative exercise and nutritional therapies on nutritional status, physical fitness, and postoperative outcomes of patients undergoing an invasive HPB surgery for malignancy.
Patients who underwent open abdominal surgeries for HPB malignancies (major hepatectomy, pancreatoduodenectomy, or hepato-pancreatoduodenectomy) between 2016 and 2017 were subjected to prehabilitation. Patients before the introduction of prehabilitation were included as historical control subjects for 1:1 propensity score-matching (no-prehabilitation group). The preoperative nutritional status and postoperative course were compared between the two groups.
The prehabilitation group consisted of 76 patients scheduled to undergo HPB surgeries for malignancy. An identical number of patients were selected as the no-prehabilitation group after propensity score-matching. During the waiting period, serum albumin levels were significantly deteriorated in the no-prehabilitation group, whereas this index did not deteriorate or even improved in the prehabilitation group. By performing prehabilitation, a 6-min walk distance and total muscle/fat ratio were significantly increased during the waiting period. Although the overall incidence of postoperative complications did not differ between the two groups, the postoperative hospital stay was shorter in the prehabilitation group than in the no-prehabilitation group (median, 23 vs 30 days; p = 0.045).
The introduction of prehabilitation prevented nutritional deterioration, improved physical fitness before surgery, and shortened the postoperative hospital stay for the patients undergoing HPB surgeries for malignancy.
术前康复对肝胆胰恶性肿瘤患者的体能和术后病程的影响尚不清楚。本研究旨在探讨术前运动和营养治疗对接受侵袭性肝胆胰恶性肿瘤手术患者的营养状况、体能和术后结局的影响。
2016 年至 2017 年间，接受开放性腹部肝胆胰恶性肿瘤手术（肝切除术、胰十二指肠切除术或胰肝十二指肠切除术）的患者接受了术前康复。将术前未行康复治疗的患者作为 1:1 倾向评分匹配的历史对照（无康复组）。比较两组患者的术前营养状况和术后病程。
术前康复组 76 例患者拟行肝胆胰恶性肿瘤手术。通过倾向评分匹配，选择了相同数量的患者作为无康复组。在等待期间，无康复组的血清白蛋白水平显著恶化，而康复组该指标未恶化甚至有所改善。通过进行术前康复，患者在等待期间的 6 分钟步行距离和总肌肉/脂肪比显著增加。尽管两组患者的术后总体并发症发生率无差异，但康复组的术后住院时间短于无康复组（中位数 23 天 vs 30 天；p=0.045）。
术前康复可防止营养恶化，改善手术前的体能，并缩短肝胆胰恶性肿瘤患者的术后住院时间。
