Department of Surgery and Cancer, Imperial College London, London, UK.
Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
Ann Surg Oncol. 2022 May;29(5):3148-3167. doi: 10.1245/s10434-021-11122-7. Epub 2021 Dec 27.
Esophageal and gastric cancer surgery are associated with considerable morbidity, specifically postoperative pulmonary complications (PPCs), potentially accentuated by underlying challenges with malnutrition and cachexia affecting respiratory muscle mass. Physiotherapy regimens aim to increase the respiratory muscle strength and may prevent postoperative morbidity.
The aim of this study was to assess the impact of physiotherapy regimens in patients treated with esophagectomy or gastrectomy.
An electronic database search was performed in the MEDLINE, EMBASE, CENTRAL, CINAHL and Pedro databases. A meta-analysis was performed to assess the impact of physiotherapy on the functional capacity, incidence of PPCs and postoperative morbidity, in-hospital mortality rate, length of hospital stay (LOS) and health-related quality of life (HRQoL).
Seven randomized controlled trials (RCTs) and seven cohort studies assessing prehabilitation totaling 960 patients, and five RCTs and five cohort studies assessing peri- or postoperative physiotherapy with 703 total patients, were included. Prehabilitation resulted in a lower incidence of postoperative pneumonia and morbidity (Clavien-Dindo score ≥ II). No difference was observed in functional exercise capacity and in-hospital mortality following prehabilitation. Meanwhile, peri- or postoperative rehabilitation resulted in a lower incidence of pneumonia, shorter LOS, and better HRQoL scores for dyspnea and physical functioning, while no differences were found for the QoL summary score, global health status, fatigue, and pain scores.
This meta-analysis suggests that implementing an exercise intervention may be beneficial in both the preoperative and peri- or postoperative periods. Further investigation is needed to understand the mechanism through which exercise interventions improve clinical outcomes and which patient subgroup will gain the maximal benefit.
食管癌和胃癌手术与相当大的发病率有关，特别是术后肺部并发症（PPCs），这可能因营养不良和恶病质影响呼吸肌质量的潜在挑战而加重。物理治疗方案旨在增加呼吸肌力量，并可能预防术后发病率。
本研究旨在评估物理治疗方案对接受食管切除术或胃切除术治疗的患者的影响。
在 MEDLINE、EMBASE、CENTRAL、CINAHL 和 Pedro 数据库中进行电子数据库搜索。进行荟萃分析以评估物理治疗对功能能力、PPC 发生率和术后发病率、住院内死亡率、住院时间（LOS）和健康相关生活质量（HRQoL）的影响。
纳入了 7 项评估预康复的随机对照试验（RCT）和 7 项队列研究，共 960 例患者，以及 5 项评估围手术期或术后物理治疗的 RCT 和 5 项队列研究，共 703 例患者。预康复可降低术后肺炎和发病率（Clavien-Dindo 评分≥ II）的发生率。预康复后，功能运动能力和住院内死亡率无差异。同时，围手术期或术后康复可降低肺炎发生率、缩短 LOS，改善呼吸困难和身体功能的 HRQoL 评分，而 QoL 综合评分、总体健康状况、疲劳和疼痛评分无差异。
本荟萃分析表明，在术前和围手术期实施运动干预可能是有益的。需要进一步研究以了解运动干预改善临床结果的机制以及哪些患者亚组将获得最大收益。
