Diaz-Feijoo Berta, Agusti-Garcia Nuria, Sebio Raquel, López-Hernández Antonio, Sisó Marina, Glickman Ariel, Carreras-Dieguez Nuria, Fuste Pere, Marina Tiermes, Martínez-Egea Judit, Aguilera Laura, Perdomo Juan, Pelaez Amaia, López-Baamonde Manuel, Navarro-Ripoll Ricard, Gimeno Elena, Campero Betina, Torné Aureli, Martinez-Palli Graciela, Arguis María J
Gynecologic Oncology Unit, Clinic Institute of Gynecology, Obstetrics, and Neonatology, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, 08036 Barcelona, Spain.
Department of Rehabilitation, Hospital Clinic de Barcelona, 08036 Barcelona, Spain.
Cancers (Basel). 2022 Mar 23;14(7):1635. doi: 10.3390/cancers14071635.
Treatment for advanced ovarian cancer (AOC) comprises cytoreductive surgery combined with chemotherapy. Multimodal prehabilitation programmes before surgery have demonstrated efficacy in postoperative outcomes in non-gynaecological surgeries. However, the viability and effects of these programmes on patients with AOC are unknown. We aimed to evaluate the feasibility and postoperative impact of a multimodal prehabilitation programme in AOC patients undergoing surgery.
This single-centre, before-and-after intervention pilot study included 34 patients in two cohorts: the prehabilitation cohort prospectively included 15 patients receiving supervised exercise, nutritional optimisation, and psychological preparation from December 2019 to January 2021; the control cohort included 19 consecutive patients between January 2018 and November 2019. Enhanced Recovery After Surgery guidelines were followed.
The overall adherence to the multimodal prehabilitation programme was 80%, with 86.7% adherence to exercise training, 100% adherence to nutritional optimisation, and 80% adherence to psychological preparation. The median hospital stay was shorter in the prehabilitation cohort (5 (IQR, 4-6) vs. 7 days (IQR, 5-9) in the control cohort, = 0.04). Differences in postoperative complications using the comprehensive complication index (CCI) were not significant (CCI score: 9.3 (SD 12.12) in the prehabilitation cohort vs. 16.61 (SD 16.89) in the control cohort, = 0.08). The median time to starting chemotherapy was shorter in the prehabilitation cohort (25 (IQR, 23-25) vs. 35 days (IQR, 28-45) in the control cohort, = 0.03).
A multimodal prehabilitation programme before cytoreductive surgery is feasible in AOC patients with no major adverse effects, and results in significantly shorter hospital stays and time to starting chemotherapy.
晚期卵巢癌（AOC）的治疗包括减瘤手术联合化疗。术前多模式预康复方案已在非妇科手术的术后结局方面显示出疗效。然而，这些方案对AOC患者的可行性和效果尚不清楚。我们旨在评估多模式预康复方案对接受手术的AOC患者的可行性及术后影响。
这项单中心、干预前后对照的试点研究纳入了两个队列的34例患者：预康复队列前瞻性纳入了2019年12月至2021年1月期间接受监督运动、营养优化和心理准备的15例患者；对照队列包括2018年1月至2019年11月期间连续的19例患者。遵循术后加速康复指南。
多模式预康复方案的总体依从率为80%，其中运动训练依从率为86.7%，营养优化依从率为100%，心理准备依从率为80%。预康复队列的中位住院时间较短（5天（四分位间距，4 - 6天），而对照队列中位住院时间为7天（四分位间距，5 - 9天），P = 0.04）。使用综合并发症指数（CCI）评估，术后并发症差异无统计学意义（预康复队列CCI评分为9.3（标准差12.12），对照队列CCI评分为16.61（标准差16.89），P = 0.08）。预康复队列开始化疗的中位时间较短（25天（四分位间距，23 - 25天），对照队列中位时间为35天（四分位间距，28 - 45天），P = 0.03）。
减瘤手术前的多模式预康复方案对AOC患者可行且无重大不良反应，可显著缩短住院时间和开始化疗的时间。
