接受腹部大手术的外科肿瘤患者的术前康复结局：一项随机对照试验的荟萃分析
Prehabilitation Outcomes in Surgical Oncology Patients Undergoing Major Abdominal Surgery: A Meta-analysis of Randomized Control Trials.
作者信息
Soh Natalie Hann, Yau Charles Rong Zhang, Low Xi Zhi, Kadir Hanis Abdul, Fong Wei Jing, Ramalingam Mothi Babu, Tan Pei Ling, Ng Kennedy Yao Yi, Hsing Ya Ting, Cai Mingzhe, Seo Chin Jin, Ong Johnny Chin-Ann, Chia Claramae S, Wong Jolene Si Min
机构信息
Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore.
Duke-NUS Medical School, Singapore, Singapore.
出版信息
Ann Surg Oncol. 2025 Feb;32(2):1236-1247. doi: 10.1245/s10434-024-16527-8. Epub 2024 Nov 30.
BACKGROUND
Prehabilitation has been increasingly utilized to optimize perioperative outcomes. In this study, we aim to evaluate the impact of uni- and multimodal prehabilitation on functional capacity and postoperative outcomes among surgical oncology patients undergoing major abdominal surgery.
PATIENTS AND METHODS
Three electronic databases (PubMed, Embase, Cochrane) were systematically searched up until December 2023. We included randomized controlled trials comparing prehabilitation to standard of care in surgical oncology patients undergoing major abdominal surgery. Our primary outcome was functional capacity as measured by the 6-min walk distance (6MWD). Secondary outcomes include postoperative complications, emergency readmissions, and length of stay (LOS). We stratified our findings to determine the impact of uni- versus multimodal prehabilitation on outcomes.
RESULTS
We included 27 studies with 2532 surgical oncology patients. Overall, patients undergoing prehabilitation demonstrated a significant improvement in preoperative functional capacity compared to those without prehabilitation (mean difference in 6MWD 28.32 meters [m], 95% CI 15.26, 41.39, p < 0.01). Prehabilitation was also associated with significantly lower odds of postoperative complications (odds ratio [OR] 0.60, 95% CI 0.46, 0.78, p < 0.01). There was no difference in emergency readmission (OR 0.90, 95% CI 0.59, 1.38, p = 0.61) or LOS (mean difference -0.42 days, 95% CI -1.01, 0.16, p = 0.15). Comparing uni- versus multimodal prehabilitation, multimodal prehabilitation was associated with greater improvements in functional capacity (6MWD 37.35 m versus 13.38 m) and lower odds of postoperative complications (OR 0.61, 95% CI 0.45, 0.82, p < 0.01 versus OR 0.63, 95% CI 0.36, 1.11, p = 0.10) CONCLUSION: Prehabilitation improves functional capacity and reduces postoperative complications among surgical oncology patients undergoing major abdominal surgery.
背景
术前康复已越来越多地用于优化围手术期结局。在本研究中，我们旨在评估单模式和多模式术前康复对接受大型腹部手术的外科肿瘤患者的功能能力和术后结局的影响。
患者与方法
系统检索了截至2023年12月的三个电子数据库（PubMed、Embase、Cochrane）。我们纳入了比较术前康复与接受大型腹部手术的外科肿瘤患者标准治疗的随机对照试验。我们的主要结局是通过6分钟步行距离（6MWD）测量的功能能力。次要结局包括术后并发症、急诊再入院和住院时间（LOS）。我们对研究结果进行分层，以确定单模式与多模式术前康复对结局的影响。
结果
我们纳入了27项研究，共2532例外科肿瘤患者。总体而言，与未接受术前康复的患者相比，接受术前康复的患者术前功能能力有显著改善（6MWD的平均差异为28.32米[m]，95%CI为15.26,41.39，p<0.01）。术前康复还与术后并发症的发生率显著降低相关（优势比[OR]为0.60，95%CI为0.46,0.78，p<0.01）。急诊再入院率（OR为0.90，95%CI为0.59,1.38，p=0.61）或住院时间（平均差异为-0.42天，95%CI为-1.01,0.16，p=0.15）没有差异。比较单模式与多模式术前康复，多模式术前康复与功能能力的更大改善（6MWD为37.35米对13.38米）和术后并发症的更低发生率相关（OR为0.61，95%CI为0.45,0.82，p<0.01对OR为0.63，95%CI为0.36,1.11，p=0.10）。结论：术前康复可改善接受大型腹部手术的外科肿瘤患者的功能能力并减少术后并发症。
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