Department of Cardiothoracic Surgery, Jinling Hospital, School of Medicine, Southeast University, Nanjing, China.
Department of Cardiothoracic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Cancer Med. 2024 Jul;13(14):e70023. doi: 10.1002/cam4.70023.
Meta-analyses have primarily focused on the effects of exercise-based prehabilitation on postoperative outcomes and ignored the role of nutritional intervention. In this study, we filled this gap by investigating the effect of nutrition-based prehabilitation on the postoperative outcomes of patients who underwent esophagectomy and gastrectomy.
Five electronic databases, namely, PubMed, the Web of Science, Embase, Cochrane Library, and CINAHL, were searched. Adults diagnosed with esophagogastric cancer who were scheduled to undergo surgery and had undergone uni- or multimodal prehabilitation, with at least a week of mandatory nutritional intervention, were included. Forest plots were used to extract and visualize the data from the included studies. The occurrence of any postoperative complication was considered the primary endpoint.
Eight studies met the eligibility criteria, with five randomized controlled trials (RCTs) and three cohort studies. In total, 661 patients were included. Any prehabilitation, that is, unimodal (only nutrition) and multimodal prehabilitation, collectively decreased the risk of any postoperative complication by 23% (95% confidence interval [CI] = 0.66-0.90). A similar effect was exclusively observed for multimodal prehabilitation (risk ratio [RR] = 0.78, 95% CI = 0.66-0.93); however, it was not significant for unimodal prehabilitation. Any prehabilitation significantly decreased the length of hospital stay (LOS) (weighted mean difference = -0.77, 95% CI = -1.46 to -0.09).
Nutrition-based prehabilitation, particularly multimodal prehabilitation, confers protective effects against postoperative complications after esophagectomy and gastrectomy. Our findings suggest that prehabilitation slightly decreases LOS; however, the finding is not clinically significant. Therefore, additional rigorous RCTs are warranted for further substantiation.
荟萃分析主要集中在基于运动的术前康复对术后结果的影响，而忽略了营养干预的作用。在这项研究中，我们通过研究营养为基础的术前康复对接受食管和胃切除术的患者的术后结果的影响来填补这一空白。
检索了五个电子数据库，即 PubMed、Web of Science、Embase、Cochrane Library 和 CINAHL。纳入了诊断为食管胃肿瘤、计划接受手术且接受了单一或多模式术前康复、至少进行了一周强制性营养干预的成年人。使用森林图提取和可视化纳入研究的数据。任何术后并发症的发生均被视为主要终点。
符合条件的研究有 8 项，其中 5 项为随机对照试验（RCT），3 项为队列研究。共纳入 661 名患者。任何术前康复，即单一模式（仅营养）和多模式术前康复，均可降低 23%的任何术后并发症风险（95%置信区间[CI]为 0.66-0.90）。多模式术前康复的效果类似（风险比[RR]为 0.78，95%CI 为 0.66-0.93）；然而，对于单一模式术前康复，效果不显著。任何术前康复均显著降低住院时间（LOS）（加权均数差[WMD]为-0.77，95%CI 为-1.46 至-0.09）。
基于营养的术前康复，特别是多模式术前康复，对食管和胃切除术术后并发症具有保护作用。我们的研究结果表明，术前康复可轻微缩短 LOS，但该发现无临床意义。因此，需要进行更多严格的 RCT 以进一步证实。
