Raso Kristy-Lee, Suen Michael, Egger Sam, Turner Jane, Khatri Sonia, Lin Yanlan, Wildbore Carolyn, Scales Caoimhe, Gerber Shannon, Chan Kin Yin Carol, Becerril-Martinez Guillermo, Le Page Philip, Tan Sim Yee Cindy, Vardy Janette
Department of Nutrition and Dietetics, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
Support Care Cancer. 2025 May 8;33(6):458. doi: 10.1007/s00520-025-09496-5.
Surgery remains the primary treatment for early-stage colorectal and upper gastrointestinal (UGI) cancers. However, it can lead to postoperative complications and reduced functionality. Prehabilitation aims to improve functional reserves before surgery. We aimed to evaluate the implementation of a multimodal prehabilitation program in "real-world" patients undergoing gastrointestinal cancer surgery.
An implementation study evaluating prehabilitation in patients undergoing gastrointestinal (colorectal or UGI) cancer surgery at Concord Hospital. The prehabilitation program included supervised exercise, nutrition and nursing support delivered face-to-face or by telehealth (COVID-19 adaptations).
baseline, pre-surgery and 30 days after surgery.
implementation using the RE-AIM (Reach/Effectiveness/Adoption/Implementation/Maintenance) framework.
functional, nutritional and surgical outcomes, with comparisons to historical controls.
Between January 2020 and December 2021, 181 patients were screened; 91 (50%) were eligible. Reach: 77/91 recruited (63 colorectal, 14 UGI). Median age, 70 years (IQR, 59-79); 60% were males. Median intervention duration, 16 days (IQR, 12.25-19.75).
quality of life, anxiety and functional capacity improved from baseline to pre-surgery (6-min walk test (+16.1 m, p=0.038) and 2-min step test (+10.0 steps, p<0.001)). Compared to historical controls, hospital length of stay was reduced by 2.1 days (p=0.010), with no differences in complications. Adoption: 91% of referrals came directly from surgeons.
94% completed the intervention, with high adherence and satisfaction levels. Maintenance: after study completion, the program was incorporated into standard care with some modifications.
Prehabilitation can be implemented in a real-world setting, with a trend towards improving functional and surgical outcomes, but dedicated resources are necessary to implement and maintain the program.
手术仍是早期结直肠癌和上消化道（UGI）癌的主要治疗方法。然而，手术可能导致术后并发症并降低功能。术前康复旨在提高手术前的功能储备。我们旨在评估在接受胃肠道癌手术的“真实世界”患者中实施多模式术前康复计划的情况。
一项实施研究，评估在康科德医院接受胃肠道（结直肠癌或UGI）癌手术患者的术前康复情况。术前康复计划包括面对面或通过远程医疗（针对COVID-19的调整）提供的有监督的运动、营养和护理支持。
基线、术前和术后30天。
使用RE-AIM（覆盖范围/有效性/采用率/实施情况/维持情况）框架进行实施评估。
功能、营养和手术结果，并与历史对照进行比较。
2020年1月至2021年12月期间，筛查了181例患者；91例（50%）符合条件。覆盖范围：招募了77/91例（63例结直肠癌，14例UGI）。中位年龄70岁（四分位间距，59 - 79岁）；60%为男性。中位干预持续时间为16天（四分位间距，12.25 - 19.75天）。
从基线到术前，生活质量、焦虑和功能能力得到改善（6分钟步行试验（增加16.1米，p = 0.038）和2分钟阶梯试验（增加10.0步，p < 0.001））。与历史对照相比，住院时间缩短了2.1天（p = 0.010），并发症无差异。采用率：91%的转诊直接来自外科医生。
94%完成了干预，依从性和满意度较高。维持情况：研究完成后，该计划经一些修改后纳入了标准护理。
术前康复可以在真实世界环境中实施，有改善功能和手术结果的趋势，但实施和维持该计划需要专门的资源。
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