University of Washington School of Medicine, Seattle, Washington.
Icahn School of Medicine at Mount Sinai, New York, New York.
Curr Opin Urol. 2024 Nov 1;34(6):477-483. doi: 10.1097/MOU.0000000000001224. Epub 2024 Aug 30.
Prehabilitation describes interventions that are undertaken prior to a major surgical or medical intervention with the objective of improving functional capability with the goal of improving candidacy for therapy, bolstering one's ability to withstand treatment-associated toxicity, functional decline, and facilitating accelerated recovery. The objective of this review is to detail the key tenets of prehabilitation, synthesize contemporary advances in prehabilitation science within Urologic Oncology , and discuss key methodologic trial design considerations salient to future prehabilitation investigations.
Contemporary prehabilitation clinical trials have primarily evaluated unimodal interventions aiming to improve functional capacity across the domains of physical exercise, nutrition, and cognition with heightened interest in evaluating multimodal interventions addressing two or more domains. Recent investigations have have demonstrated variable improvements in strength, balance, physical function, and quality of life with preoperative exercise. Although presurgical immunonutrition showed promise in other fields, initial results in uro-oncology have not demonstrated reductions in complications nor improvements in early survival. Emerging data supports the potential of multimodal prehabilitation programs to offer more comprehensive benefits, improving functional outcomes, reducing length of stay, and supporting improved recovery.
To date, early prehabilitation studies in patients undergoing surgery for genitourinary malignancies have demonstrated variable ability to facilitate gains in functional capacity and perioperative outcomes. Key issues have arisen including the need to ensure that interventions are pragmatic, scalable, feasible, and acceptable in these populations that often also have a high prevalence of coincident multimorbidity, frailty, and mental health concerns that can increase risk of adverse outcomes after surgery. The integration of personalized prehabilitation strategies as extensions of perioperative enhanced recovery after surgery protocols, supportive care and survivorship paradigms offers of promise to further engage patients in their care, enhance patient resilience and outcomes, while reducing treatment burden in urologic oncology.
术前康复描述了在主要手术或医疗干预之前进行的干预措施，其目的是提高功能能力，从而提高治疗的候选资格，增强耐受治疗相关毒性、功能下降的能力，并促进加速康复。本综述的目的是详细阐述术前康复的关键原则，综合当代泌尿肿瘤学中术前康复科学的进展，并讨论对未来术前康复研究有重要意义的关键方法学试验设计考虑因素。
当代术前康复临床试验主要评估了单一模式干预措施，旨在改善身体锻炼、营养和认知等领域的身体功能，并且越来越关注评估针对两个或多个领域的多模式干预措施。最近的研究表明，术前运动可使力量、平衡、身体功能和生活质量得到不同程度的改善。尽管术前免疫营养在其他领域有一定的前景，但在泌尿肿瘤学中的初步结果并未显示并发症减少或早期生存改善。新出现的数据支持多模式术前康复计划提供更全面的益处的潜力，改善功能结局，缩短住院时间，并支持更好的恢复。
迄今为止，对接受泌尿生殖系统恶性肿瘤手术的患者进行的早期术前康复研究显示，在促进功能能力和围手术期结局方面的能力各不相同。出现了一些关键问题，包括需要确保干预措施在这些人群中具有实用性、可扩展性、可行性和可接受性，这些人群通常还存在多种合并症、虚弱和心理健康问题的高发率，这些问题会增加手术后不良结局的风险。将个性化术前康复策略整合为围手术期强化康复后治疗方案、支持性护理和生存模式的延伸，为进一步让患者参与其治疗、增强患者的韧性和结局，同时减轻泌尿肿瘤学的治疗负担提供了希望。
