Xu Shasha, Yin Rong, Zhu Haiou, Gong Yin, Zhu Jing, Li Changxian, Xu Qin
Department of Hepatobiliary Center, the First Affiliated Hospital of Nanjing Medical University, No.300, Guangzhou Road, Gulou District, Nanjing, 210000, Jiangsu Province, China.
Department of Nursing School, Nanjing Medical University, Nanjing, 210000, Jiangsu Province, China.
BMC Gastroenterol. 2025 Jan 22;25(1):26. doi: 10.1186/s12876-025-03626-3.
Prehabilitation is a crucial component of tumor rehabilitation that attempts to improve patients' preoperative health, although its efficacy in treating patients with cancers of the digestive system is still up for debate.
The records from PubMed (MEDLINE), Embase, Web of Science, Cochrane Library, EBSCO, Scopus, CNKI and Wan fang database up to November 2024 were systematically searched. The Cochrane Collaboration tool was employed for evaluating the risk of bias in each study, and the PRISMA 2020 checklist provided by the EQUATOR network was utilized.
Through quality analysis, 20 articles were included, involving 1719 patients. Although its effect on severe complications is still unknown, the prehabilitation significantly decreased overall postoperative complications when compared to standard care, with a risk ratio (RR) of 0.74 (95% CI: 0.65 to 0.84). Despite not shortening the postoperative hospital stay (MD: -0.13, 95% CI: -0.29 to 0.03), prehabilitation demonstrated notable improvements in the 6-minute walk distance (6MWD), with preoperative gains (MD: 25.87, 95% CI: 14.49 to 37.25) and sustained benefits at 4 weeks postoperatively (MD: 22.48, 95% CI: 7.85 to 37.12). However, no significant differences in 6MWD were observed at 6 or 8 weeks postoperatively. The average improvement in 6MWD from baseline to preoperative was 28.99 (95% CI: 10.89 to 47.08, P = 0.002), and from 4 weeks postoperative to baseline, it was 25.95 (95% CI: 6.84 to 45.07, P = 0.008), with no significant change at 8 weeks. The acceptance and completion rates of prehabilitation were commendably high at 61% (95% CI: 47-75%) and 90% (95% CI: 87-93%), respectively, alongside a relatively low dropout rate of 10% (95% CI: 7% to13%).
Prehabilitation reduces postoperative complications and improves short-term physical function in digestive surgery patients, with good patient acceptance; however, the long-term effects are unknown due to a lack of follow-up data.
It was registered with the International Prospective Register of Systematic Reviews (PROSPERO) with the identification code CRD42022361100.
术前康复是肿瘤康复的关键组成部分，旨在改善患者术前健康状况，但其对消化系统癌症患者的疗效仍存在争议。
系统检索截至2024年11月的PubMed（MEDLINE）、Embase、Web of Science、Cochrane图书馆、EBSCO、Scopus、中国知网和万方数据库。采用Cochrane协作工具评估每项研究的偏倚风险，并使用EQUATOR网络提供的PRISMA 2020清单。
通过质量分析，纳入20篇文章，涉及1719例患者。尽管其对严重并发症的影响尚不清楚，但与标准护理相比，术前康复显著降低了总体术后并发症，风险比（RR）为0.74（95%CI：0.65至0.84）。尽管术前康复未缩短术后住院时间（MD：-0.13，95%CI：-0.29至0.03），但在6分钟步行距离（6MWD）方面有显著改善，术前增加（MD：25.87，95%CI：14.49至37.25），术后4周持续受益（MD：22.48，95%CI：7.85至37.12）。然而，术后6周或8周时6MWD无显著差异。从基线到术前，6MWD的平均改善为28.99（95%CI：10.89至47.08，P = 0.002），从术后4周到基线，改善为25.95（95%CI：6.84至45.07，P = 0.008），8周时无显著变化。术前康复的接受率和完成率分别高达61%（95%CI：47-75%）和90%（95%CI：87-93%），辍学率相对较低，为10%（95%CI：7%至13%）。
术前康复可降低消化外科手术患者的术后并发症，改善短期身体功能，患者接受度良好；然而，由于缺乏随访数据，长期效果尚不清楚。
已在国际系统评价前瞻性注册库（PROSPERO）注册，识别码为CRD42022361100。
