Division of Surgery and Perioperative Medicine, Flinders Medical Center, Bedford Park, Adelaide, South Australia, Australia.
Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India.
Clin Nutr ESPEN. 2024 Oct;63:845-855. doi: 10.1016/j.clnesp.2024.08.003. Epub 2024 Aug 22.
Enhancing a patient's functional capacity to withstand the surgical stress by means of multimodal (combined exercise, nutrition and psychological interventions) prehabilitation may potentially lead to improved outcomes in pancreatic cancer surgery.
A systematic review was undertaken searching PubMed, Google Scholar and Cochrane Library databases, exploring the impact of prehabilitation in pancreatic surgery. Outcomes of interest were adherence to the prehabilitation, functional capacity, overall complications and post-operative length of stay. Pooled analysis was performed using a random-effects model.
Twelve studies comprising of 1497 patients were included in the review. Most of the studies seem to lack a multimodal approach. Less than 50 % of the studies reported adherence, which ranged between 27 and 100 %. Functional capacity, in terms of 6-min walk test, showed improvement with prehabilitation. Among the post-operative outcomes, prehabilitation was associated with significant improvement in pulmonary complications (2.4 % versus 6.7 %, RR 0.36, CI 0.17-0.74, p = 0.01, I = 28%). Prehabilitation was not effective in terms of length of stay or readmission rates.
Larger studies with multimodal prehabilitation approaches may demonstrate more consistent and clinically meaningful benefits, which would lead to a firm appreciation of its role the management of pancreatic cancer patients undergoing surgery.
通过多模式（联合运动、营养和心理干预）康复来增强患者承受手术应激的功能能力，可能会改善胰腺癌手术的结果。
系统检索 PubMed、Google Scholar 和 Cochrane Library 数据库，探讨康复对胰腺手术的影响。感兴趣的结果是对康复的依从性、功能能力、总体并发症和术后住院时间。使用随机效应模型进行汇总分析。
共纳入 12 项研究，包括 1497 例患者。大多数研究似乎缺乏多模式方法。不到 50%的研究报告了依从性，范围在 27%至 100%之间。以 6 分钟步行测试衡量的功能能力，经康复后有所改善。在术后结果中，康复与肺并发症的显著改善相关（2.4%比 6.7%，RR 0.36，CI 0.17-0.74，p=0.01，I=28%）。康复在住院时间或再入院率方面没有效果。
采用多模式康复方法的更大规模研究可能会显示出更一致和更有临床意义的益处，这将使人们更坚定地认识到它在管理接受手术的胰腺癌患者方面的作用。
