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Sagawa M, Matsui R, Sano A, Sakai M, Hiraoka S, Tabei I, Imai T, Matsumoto H, Onogawa S, Sonoi N, Nagata S, Ogawa R, Wakiyama S, Miyazaki Y, Kumagai K, Tsutsumi R, Okabayashi T, Uneno Y, Higashibeppu N, Kotani J. Perioperative or combined preoperative and postoperative standard nutrition therapy for patients with head and neck or gastrointestinal cancer: A systematic review and meta-analysis. Clin Nutr ESPEN 2025; 67:567-577. [PMID: 40189145 DOI: 10.1016/j.clnesp.2025.03.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 03/19/2025] [Accepted: 03/25/2025] [Indexed: 04/13/2025]
Abstract
BACKGROUND & AIMS Since malnutrition is a risk factor for postoperative complications, preoperative nutritional therapy is recommended to reduce postoperative complications. Few meta-analyses conducted exclusively in cancer patients have shown that perioperative standard nutritional therapy reduces postoperative complications. This study examined whether preoperative or combined preoperative and postoperative standard nutritional therapy reduced postoperative complications in patients with head and neck or gastrointestinal (GI) cancer. METHODS We conducted randomized controlled trials in 1979-2021. Patients who received standard nutritional interventions were classified as the intervention group and those who did not receive any nutritional intervention as controls. The primary outcome was the total number of postoperative complications and infectious complications. RESULTS In total, 19 studies were included (n = 2047). Of 19 studies, 5 were for upper GI cancer, 8 were for lower GI cancer, 5 were for upper and lower GI cancers, and 1 was for head and neck cancer. Total postoperative and infectious complications were reported in 15 (n = 1762) and 9 (n = 905) studies. The meta-analysis showed that standard nutritional interventions may reduce the total complication rates (RR: 0.78, 95 % CI: 0.65-0.94) and infectious complications (RR: 0.67, 95 % CI: 0.51-0.87). There were no significant differences in subgroup analyses, according to the nutritional therapy timing and nutritional status. The risk of bias was high for random sequence generation, allocation concealment, and participants' and data analysts' blinding. COE for total postoperative and infectious complications was weak and inconsistent due to the high risk of bias and substantial heterogeneity. CONCLUSION Although the present study was inconclusive due to the small number of studies in head and neck cancer, preoperative or combined preoperative and postoperative standard nutrition therapy in patients with GI cancer may significantly reduce the incidence of postoperative complications. Further studies are needed to confirm these findings and to reduce the risk of bias.
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Affiliation(s)
- Masano Sagawa
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Surgery, Tokyo Women's Medical University Adachi Medical Center, Japan.
| | - Ryota Matsui
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Japan.
| | - Akihiko Sano
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Division of Gastroenterological Surgery, Department of General Surgical Science, Gunma University, Graduate School of Medicine, Japan.
| | - Makoto Sakai
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Division of Gastroenterological Surgery, Department of General Surgical Science, Gunma University, Graduate School of Medicine, Japan.
| | - Shinichiro Hiraoka
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; 1st Department of Oral and Maxillofacial Surgery, Graduate School of Dentistry, Osaka University, Japan.
| | - Isao Tabei
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Surgery, The Jikei University School of Medicine, Daisan Hospital, Japan.
| | - Takayuki Imai
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Head and Neck Surgery, Miyagi Cancer Center, Japan.
| | - Hideo Matsumoto
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Surgery, Public Mitsugi General Hospital, Japan.
| | - Seiji Onogawa
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Gastroenterology, Onomichi General Hospital, Japan.
| | - Norihiro Sonoi
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Center for Education in Medicine and Health Sciences, Okayama University, Japan.
| | - Shigeyuki Nagata
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Surgery, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Japan.
| | - Ryo Ogawa
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Japan.
| | - Shigeki Wakiyama
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Surgery, Machida Municipal Hospital, Japan.
| | - Yasuhiro Miyazaki
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Gastroenterological Surgery, Osaka General Medical Center, Japan.
| | - Koshi Kumagai
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Surgery, Tokyo Women's Medical University Adachi Medical Center, Japan.
| | - Rie Tsutsumi
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Nutrition and Metabolism, Institute of Health Biosciences, Tokushima University Graduate School, Japan.
| | - Takehiro Okabayashi
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Gastroenterological Surgery, Kochi Health Sciences Center, Japan.
| | - Yu Uneno
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Japan.
| | - Naoki Higashibeppu
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Department of Anesthesia and Critical Care, Kobe City Medical Center General Hospital, Japan.
| | - Joji Kotani
- The Guidelines Committee, Japanese Society for Clinical Nutrition and Metabolism, Japan; Division of Disaster and Emergency Medicine, Department of Surgery Related Kobe University Graduate School of Medicine, Japan.
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Gao S, He Y, Jiang L, Yang J. Multimodal prehabilitation program for patients undergoing elective surgery for colorectal cancer: a scoping review. Front Oncol 2025; 15:1532624. [PMID: 40386553 PMCID: PMC12082037 DOI: 10.3389/fonc.2025.1532624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2024] [Accepted: 04/07/2025] [Indexed: 06/01/2025] Open
Abstract
Objectives Multimodal prehabilitation has been widely used in patients undergoing surgery for colorectal cancer and has improved clinical outcomes. The aim of this scoping review is to review the content and current state of clinical practice of multimodal prehabilitation programs. Methods A systematic literature review of multimodal prehabilitation studies in patients undergoing colorectal cancer surgery was conducted according to the PRISMA extension framework for scoping reviews. The literature was searched via the PubMed, Web of Science, SCOPUS, EMBASE and Cochrane Library databases. The results of the study included the components of multimodal prehabilitation (exercise, nutritional, and psychological interventions) and related evaluation indicators, duration, and compliance-related components. Results This review included 12 studies with 9 randomized controlled trials, 1 pilot intervention study, 1 cohort study, and 1 mock-target trial design. Specific protocols for multimodal rehabilitation training vary widely, ranging in duration from 2-8 weeks, and were implemented in healthcare facilities, the community, and at home. Adherence rates ranged from 50% to almost 100%. Common outcome indicators include the 6-minute walk test, comorbidities, length of hospitalization, health-related quality of life, and several anxiety assessment scales. Conclusion Current evidence suggests that multimodal preconditioning has a positive effect on the clinical prognosis of patients undergoing elective colorectal cancer surgery. However, owing to the heterogeneity of multimodal rehabilitation in terms of implementation protocols and evaluation metrics, many high-quality studies are still needed to explore the optimal model of multimodal rehabilitation and promote its standardization.
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Affiliation(s)
| | | | | | - Jie Yang
- Colorectal Cancer Center, West China Hospital, Sichuan University/West China School of
Nursing, Sichuan University, Chengdu, Sichuan, China
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3
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Gillis C, Hasil L, Keane C, Brassard D, Kiernan F, Bellafronte NT, Culos-Reed SN, Gramlich L, Ljungqvist O, Fenton TR. A multimodal prehabilitation class for Enhanced Recovery After Surgery: a pragmatic randomised type 1 hybrid effectiveness-implementation trial. Br J Anaesth 2025:S0007-0912(25)00153-9. [PMID: 40199628 DOI: 10.1016/j.bja.2025.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 02/27/2025] [Accepted: 03/04/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Prehabilitation promotes postoperative recovery through preoperative optimisation; however, few studies have been conducted under real-world conditions. Our objective was to determine the extent to which a multimodal prehabilitation programme influenced intermediate and late recovery post-colorectal surgery in a type 1 effectiveness-implementation and randomised pragmatic trial. We hypothesised that a prehabilitation class, as part of an Enhanced Recovery After Surgery (ERAS) pathway, would reduce length of hospital stay (LOS). METHODS Adult male and female patients with colorectal disease requiring an elective primary resection at a single centre were randomised to the intervention or standard care group at least 2 weeks before surgery. All participants attended an ERAS class, which was extended to include prehabilitation components of nutrition education, supplements, walking with a smartwatch, functional exercises, and deep breathing in the intervention group. Effectiveness outcomes included LOS (primary) and 6-min walking distance (6MWD; secondary outcome) at 6 weeks post-surgery. Implementation outcomes included adherence to prescribed step count and nutrient intakes. Multivariable regression analyses were adjusted for age, sex, type of surgery, and COVID-19. RESULTS The study ended prematurely. In total, 110 patients were included. Two-thirds had cancer and mean prehabilitation duration was 17.2 (sd 5.5) days. LOS was not different between groups. Preoperative median step count did not differ between groups, but protein inadequacy (prevalence ratio: 0.59 [95% CI: 0.36-0.82]) decreased substantially with prehabilitation. After surgery, the mean difference in 6MWD was +38 m (95% CI: 9-67 m) for prehabilitation vs control, indicating earlier functional recovery. CONCLUSIONS A pragmatic prehabilitation programme did not influence length of hospital stay (underpowered because of early trial termination), but did reduce preoperative protein inadequacy (implementation outcome) and improve early functional recovery (secondary outcome). CLINICAL TRIAL REGISTRATION ClinicalTrials.gov (NCT04247776).
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Affiliation(s)
- Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada.
| | - Leslee Hasil
- Alberta Health Services, Nutrition Services, Calgary, AB, Canada
| | - Ciaran Keane
- Alberta Health Services, Rehabilitation Services, Calgary, AB, Canada
| | - Didier Brassard
- School of Human Nutrition, McGill University, Montreal, QC, Canada
| | - Friede Kiernan
- Faculty of Kinesiology and Department of Oncology, Cumming School of Medicine, University of Calgary, Canada
| | | | - S Nicole Culos-Reed
- Faculty of Kinesiology and Department of Oncology, Cumming School of Medicine, University of Calgary, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Olle Ljungqvist
- School of Medical Sciences, Department of Surgery, Örebro University, Örebro, Sweden
| | - Tanis R Fenton
- Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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D'Amico F, Dormio S, Veronesi G, Guarracino F, Donadello K, Cinnella G, Rosati R, Pecorelli N, Baldini G, Pieri M, Landoni G, Turi S. Home-based prehabilitation: a systematic review and meta-analysis of randomised trials. Br J Anaesth 2025; 134:1018-1028. [PMID: 39919985 PMCID: PMC11947603 DOI: 10.1016/j.bja.2025.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 12/30/2024] [Accepted: 01/01/2025] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND Prehabilitation aims to enhance preoperative functional capacity through exercise, nutrition, and psychological programs. Home-based prehabilitation represents an alternative to hospital prehabilitation, with the advantage of not utilising hospital resources. This review aims to evaluate adherence and clinical effectiveness of home-based prehabilitation. METHODS We searched PubMed, Cochrane, and Embase up to October 1, 2024 for randomised controlled trials comparing home-based prehabilitation with standard care. The primary outcome was the proportion of patients with postoperative complications. Secondary outcomes included protocol adherence, and 6-min walking test. We used risk ratios (RR) and mean differences to summarise the results. The risk of bias was assessed using RoB 2 tool. RESULTS We included 29 randomised trials for a total of 3508 patients. Median adherence to home-based prehabilitation programs was 82%. Home-based prehabilitation reduced the proportion of patients with postoperative complications (508/1322 [38.4%] vs 578/1335 [43.3%], risk ratio 0.84, 95% confidence interval [CI] 0.72-0.98, P=0.02, I2=44%, low certainty). After home-based prehabilitation, 6-min walking test performance was better compared with control (MD 28.2 m (95% CI 9.5-46.9; P<0.01, I2=48). Preoperative depression (MD -0.65, 95% CI -0.87 to -0.43; P<0.001, I2=0%), postoperative anxiety (MD -0.50, 95% CI -0.75 to -0.25; P<0.001, I2=0%, low certainty) and length of hospital stays (MD -0.32 days, 95% CI -0.61 to -0.03; P=0.03, I2=45%, low certainty) were lower with home-based prehabilitation. CONCLUSIONS Home-based prehabilitation reduced the proportion of patients with postoperative complications, but with low certainty of evidence. It also improved preoperative functional capacity, reduced hospital stays, depression and anxiety scores, with good adherence to the intervention. SYSTEMATIC REVIEW PROTOCOL PROSPERO (CRD42024591208).
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Affiliation(s)
- Filippo D'Amico
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Dormio
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Veronesi
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabio Guarracino
- Department of Cardiothoracic Anaesthesia and ICU, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Katia Donadello
- Department of Anaesthesia and Intensive Care B, Department of Surgery, Dentistry, Gynaecology and Pediatrics, University of Verona, AOUI-University Hospital Integrated Trust of Verona, Verona, Italy
| | - Gilda Cinnella
- Department of Anesthesia and Intensive Care, University Hospital of Foggia, Foggia, Italy
| | - Riccardo Rosati
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Gastrointestinal Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicolò Pecorelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriele Baldini
- Department of Health Science, University of Florence, Florence, Italy; Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Universitaria Careggi, Florence, Italy; Prehabilitation Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marina Pieri
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Giovanni Landoni
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefano Turi
- Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
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5
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Shanmugasundaram Prema S, Ganapathy D, Shanmugamprema D. Prehabilitation Strategies: Enhancing Surgical Resilience with a Focus on Nutritional Optimization and Multimodal Interventions. Adv Nutr 2025; 16:100392. [PMID: 39956387 PMCID: PMC11932842 DOI: 10.1016/j.advnut.2025.100392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 01/24/2025] [Accepted: 02/12/2025] [Indexed: 02/18/2025] Open
Abstract
Surgery imposes significant physiological and psychological stress, often leading to complications, delayed recovery, and prolonged hospital stays. Prehabilitation, a proactive strategy to optimize patients' resilience before surgery, has emerged as a transformative approach in perioperative care. Nutritional prehabilitation specifically addresses metabolic dysregulation, muscle loss, and immune suppression caused by surgical stress. This review highlights the critical role of nutritional prehabilitation within a multimodal framework, integrating exercise, psychological support, and emerging technologies. Although some evidence supports the effectiveness of prehabilitation in enhancing functional outcomes and improvements in rates of complications and mortality, its implementation faces challenges such as resources, lack of standardized protocols, and variability across healthcare settings, highlighting the need for greater standardization. Physical training as part of prehabilitation also improves mood, fosters patient engagement, and instills a sense of control over the disease process. These psychosocial benefits, alongside enhanced patient-reported outcomes and qualitative measures, reflect the holistic value of prehabilitation. Emerging technologies, such as wearable devices and telemedicine, offer scalable and personalized solutions for delivering prehabilitation, particularly in resource-limited settings. Future research should prioritize refining protocols, exploring long-term outcomes, and addressing the unique needs of high-risk populations. By emphasizing a proactive approach to perioperative care, this review aims to highlight the potential of nutritional prehabilitation as a foundational component of multimodal strategies designed to optimize surgical resilience, empower patients, and transform surgical recovery into a proactive and patient-centered journey.
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Affiliation(s)
| | - Dhanraj Ganapathy
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
| | - Deepankumar Shanmugamprema
- Department of Research Analytics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
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Markozannes G, Cividini S, Aune D, Becerra-Tomás N, Kiss S, Balducci K, Vieira R, Cariolou M, Jayedi A, Greenwood DC, Brockton NT, Croker H, Mitrou P, Copson E, Renehan AG, Bours M, Demark-Wahnefried W, Hudson MM, May AM, Odedina FT, Skinner R, Steindorf K, Tjønneland A, Velikova G, Baskin ML, Chowdhury R, Hill L, Lewis SJ, Seidell J, Weijenberg MP, Krebs J, Cross AJ, Tsilidis KK, Chan DSM. The role of physical activity, sedentary behaviour, diet, adiposity and body composition on health-related quality of life and cancer-related fatigue after diagnosis of colorectal cancer: a Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. ESMO Open 2025; 10:104301. [PMID: 40086399 PMCID: PMC11952013 DOI: 10.1016/j.esmoop.2025.104301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 01/23/2025] [Indexed: 03/16/2025] Open
Abstract
BACKGROUND The impact of physical activity, sedentary behaviour, diet, adiposity, and body composition on health-related quality of life (HRQoL) and cancer-related fatigue among colorectal cancer survivors remains uncertain. METHODS PubMed, Embase, and CENTRAL were systematically searched until April 2023 for relevant randomised controlled trials (RCTs) and cohort studies. Random-effects meta-analyses or descriptive syntheses were conducted depending on the number of studies. The evidence was interpreted and graded by an independent World Cancer Research Fund Expert Committee and Expert Panel. RESULTS We included 31 RCTs (18 exercise, 14 diet) and 30 cohort studies (8 physical activity, 3 sedentary behaviour, 13 diet, 9 adiposity and body composition). Meta-analyses were possible for exercise RCTs that showed non-significant effects but indicative of improved HRQoL (overall four trials for global HRQoL, physical and emotional well-being) and fatigue (five trials). These studies were rated at a high risk of bias (RoB), and evidence was graded as 'very low certainty of an effect'. Descriptive synthesis of interventions to improve diet quality suggested small improvements in global HRQoL and physical well-being, but with a high RoB rating leading to a 'low certainty' grading. Evidence from RCTs on probiotics and supplements and evidence from observational studies on sedentary behaviour, and various dietary and body composition factors was generally inconsistent and too scarce to draw conclusions. CONCLUSIONS Exercise and diet quality interventions might improve HRQoL and fatigue outcomes in colorectal cancer survivors. The evidence overall was limited and should be strengthened by larger, well-designed RCTs across the cancer continuum.
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Affiliation(s)
- G Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - S Cividini
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - D Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Nutrition, Oslo New University College, Oslo, Norway; Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - N Becerra-Tomás
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Basic Medical Sciences, Faculty of Medicine and Health Sciences, Rovira i Virgili University, Reus, Spain
| | - S Kiss
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - K Balducci
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - R Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - M Cariolou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - A Jayedi
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - D C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - N T Brockton
- American Institute for Cancer Research, Washington, USA
| | - H Croker
- World Cancer Research Fund International, London, UK
| | - P Mitrou
- World Cancer Research Fund International, London, UK
| | - E Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M Bours
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - W Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Alabama, USA
| | - M M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, USA
| | - A M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - F T Odedina
- Mayo Clinic Comprehensive Cancer Center, Jacksonville, Florida, USA
| | - R Skinner
- Department of Paediatric and Adolescent Haematology and Oncology, Great North Children's Hospital, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - K Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - A Tjønneland
- Danish Cancer Institute, Diet, Cancer and Health, Copenhagen, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - G Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - M L Baskin
- UPMC Hillman Cancer Center, Pittsburgh, USA
| | - R Chowdhury
- Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, USA
| | - L Hill
- American Institute for Cancer Research, Washington, USA
| | - S J Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, The Netherlands
| | - M P Weijenberg
- Department of Epidemiology, GROW Research Institute for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - J Krebs
- Department of Zoology, University of Oxford, Oxford, UK
| | - A J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - K K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - D S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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7
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Denehy L, Abo S, Swain C, Short CE, Kiss N, Khot A, Wong E, Purtill D, O'Donnell C, Klaic M, Granger CL, Tew M, Spelman T, Cavalheri V, Edbrooke L. Rehabilitation after bone marrow transplant compared with usual care to improve patient outcomes (REBOOT): protocol for a randomised controlled trial. BMC Cancer 2025; 25:532. [PMID: 40122792 PMCID: PMC11931774 DOI: 10.1186/s12885-025-13898-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Accepted: 03/10/2025] [Indexed: 03/25/2025] Open
Abstract
BACKGROUND Haematological cancer affects more than 1.3 million people around the world annually and accounted for almost 800,000 deaths globally in 2020. The number of patients with these cancers undergoing bone marrow transplant is increasing. Of note, this intensive treatment is associated with complex and multifactorial side effects, often impacting nutritional status, physical functioning and overall health-related quality of life. The primary aim of this study is to investigate the effectiveness of an eight-week multidisciplinary rehabilitation intervention compared with usual care on the physical function domain of the European Organisation for the Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30 version 3) in patients with haematological cancer following bone marrow transplant. METHODS This is a multisite, pragmatic two-arm parallel-group, randomised controlled trial (RCT) with stratified randomisation, powered for superiority, recruiting 170 participants at 30 days following either allogeneic or autologous bone marrow transplant (ACTRN12622001071718). Recruitment sites include three Australian university affiliated teaching hospitals. Participants are eligible if aged ≥ 18 years, treated for haematological cancer with allogeneic or autologous bone marrow transplant and can walk independently. The intervention group will receive eight weeks of twice weekly telehealth-based exercise classes, an initial and follow up dietetics consult, post exercise protein supplements, and a home-based physical activity program, all with embedded behaviour change strategies. The primary outcome is patient reported physical function measured using the EORTC QLQ-C30 version 3. Secondary outcomes include other domains of the EORTC QLQ-C30, fatigue, physical function, physical activity levels, frailty, body composition, sarcopenia and nutrition assessment. We will also undertake a health economic analysis alongside the trial and a process evaluation exploring intervention fidelity, causal mechanisms as well as contextual influences through qualitative enquiry. DISCUSSION The REBOOT trial will add RCT-evidence from a rigorously conducted, statistically powered multi-site trial to existing limited knowledge on the effects of multi-disciplinary rehabilitation for people with haematological cancer. If effectiveness is supported, then implementation of rehabilitation into care pathways for people having bone marrow transplant can be considered. TRIAL REGISTRATION ACTRN12622001071718 prospectively registered 03/08/2022, last updated 08/03/2024.
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Affiliation(s)
- Linda Denehy
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, 3010, Australia.
- Department of Health Services Research, Peter Maccallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.
- Department of Oncology, Sir Peter Maccallum, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Shaza Abo
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, 3010, Australia
- Department of Physiotherapy, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Christopher Swain
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, 3010, Australia
| | - Camille E Short
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, 3010, Australia
- Melbourne Centre for Behaviour Change, The University of Melbourne, 800 Swanston St, Melbourne, VIC, 3053, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, 3125, Australia
| | - Amit Khot
- Department of Oncology, Sir Peter Maccallum, University of Melbourne, Parkville, VIC, 3010, Australia
- Clinical Haematology, Peter Maccallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Eric Wong
- Clinical Haematology Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Duncan Purtill
- Department of Haematology, Fiona Stanley Hospital, Perth, WA, Australia
- Department of Haematology, Pathwest Laboratory Medicine, Perth, WA, Australia
| | - Clare O'Donnell
- Department of Physiotherapy, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - Marlena Klaic
- Melbourne School of Health Sciences, the University of Melbourne, 161 Barry Street, Parkville, VIC, 3010, Australia
| | - Catherine L Granger
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, 3010, Australia
| | - Michelle Tew
- Melbourne Health Economics, Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Tim Spelman
- Department of Health Services Research, Peter Maccallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Vinicius Cavalheri
- Faculty of Health Sciences, Curtin School of Allied Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
- Allied Health, South Metropolitan Health Service, 11 Robin Warren Drive, Murdoch, WA, 6150, Australia
| | - Lara Edbrooke
- Department of Physiotherapy, The University of Melbourne, 161 Barry Street, Parkville, VIC, 3010, Australia
- Department of Health Services Research, Peter Maccallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
- Department of Oncology, Sir Peter Maccallum, University of Melbourne, Parkville, VIC, 3010, Australia
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8
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Muchut LC, Bustos LF, Hidalgo ME, Vasile FE. Nutritional Prehabilitation: Trends in Supplementation Based on Sustainable Dairy Protein Sources. Curr Nutr Rep 2025; 14:31. [PMID: 39932655 DOI: 10.1007/s13668-025-00623-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2025] [Indexed: 05/08/2025]
Abstract
PURPOSE OF REVIEW Prehabilitation is an emerging clinical practice that aims to improve the surgical recovery and quality of life of patients undergoing intensive treatments. This review intends to describe the state of the art in prehabilitation, highlighting the role of nutritional strategies and the current trends in supplements. RECENT FINDINGS Up-to-date studies have shown the importance of optimizing the nutritional status of patients to cope with the physical and metabolic demands of surgery and intensive treatments. In the context of nutritional prehabilitation, oral nutritional supplementation has emerged as a preferred strategy. The effectiveness of prehabilitation has been demonstrated in various clinical contexts. However, the lack of standardized protocols makes it hard to compare the outcomes. Despite the variability in this type of nutritional intervention found in reports, it has been shown that the most common oral nutritional supplements (ONS) contain dairy proteins. The use of whey proteins represents a promising approach from both a nutritional and a sustainability perspective.
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Affiliation(s)
- Luciana Cecilia Muchut
- Universidad Nacional del Chaco Austral and CONICET - Instituto de investigaciones en procesos tecnológicos avanzados (INIPTA), Presidencia Roque Sáenz Pena, Comandante Fernández 755, Chaco, 3700, Argentina
| | - Leandro Fabián Bustos
- Universidad Nacional del Chaco Austral and CONICET - Instituto de investigaciones en procesos tecnológicos avanzados (INIPTA), Presidencia Roque Sáenz Pena, Comandante Fernández 755, Chaco, 3700, Argentina
| | - María Eugenia Hidalgo
- Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario (UNR) - Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Rosario, Santa Fe, 2000, Argentina
| | - Franco Emanuel Vasile
- Universidad Nacional del Chaco Austral and CONICET - Instituto de investigaciones en procesos tecnológicos avanzados (INIPTA), Presidencia Roque Sáenz Pena, Comandante Fernández 755, Chaco, 3700, Argentina.
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9
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Chitti W, Insin P, Prueksaritanond N. Effect of Whey Protein Supplementation on Postoperative Outcomes After Gynecological Cancer Surgery: A Randomized Controlled Trial. World J Oncol 2025; 16:70-82. [PMID: 39850521 PMCID: PMC11750756 DOI: 10.14740/wjon1990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Accepted: 12/27/2024] [Indexed: 01/25/2025] Open
Abstract
Background Whey protein's biochemical properties make it an ideal nutritional supplement for patients with cancer, especially in perioperative care. Thus, the present study aims to assess the efficacy of whey protein supplementation (WPS) compared to standard care in enhancing postoperative outcomes for patients undergoing comprehensive surgical staging for gynecological cancer. Methods In an open-label, randomized controlled trial conducted at Rajavithi Hospital between November 28, 2023 and July 8, 2024, 61 patients scheduled for comprehensive surgical staging were enrolled. Participants were randomized in a 1:1 ratio to either the WPS group (n = 30) or the control group (n = 31). The WPS group received isolated whey protein powder (20 g of protein per serving), administered at 6 pm before surgery and 6 am on the first postoperative day. The control group received standard postoperative care. The primary endpoint was the length of hospital stay (LOHS), with secondary outcomes including gastrointestinal function recovery, postoperative analgesic use, complications, and potential WPS-related adverse events such as transaminitis, acute kidney injury, and electrolyte imbalances. Results The WPS group had a significantly shorter LOHS than the control group (79.0 ± 6.7 vs. 93.3 ± 28.4 h, P = 0.021). Additionally, the WPS group demonstrated significant improvements in gastrointestinal function, with shorter times to first flatus (P < 0.001), first defecation (P = 0.013), and first ambulation (P = 0.043). No significant differences were observed between the groups regarding postoperative analgesic use or complications, including fever, nausea/vomiting, wound infection, and readmission (P > 0.05). Furthermore, no WPS-related adverse events were reported. Conclusion The use of WPS in the perioperative operative management of gynecological cancer surgery yields promising results by significantly reducing the LOHS and accelerating the recovery of gastrointestinal function while maintaining a favorable safety profile.
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Affiliation(s)
- Wiranchana Chitti
- Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand
| | - Putsarat Insin
- Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
| | - Nisa Prueksaritanond
- Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand
- College of Medicine, Rangsit University, Bangkok, Thailand
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10
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Soh NH, Yau CRZ, Low XZ, Kadir HA, Fong WJ, Ramalingam MB, Tan PL, Ng KYY, Hsing YT, Cai M, Seo CJ, Ong JCA, Chia CS, Wong JSM. Prehabilitation Outcomes in Surgical Oncology Patients Undergoing Major Abdominal Surgery: A Meta-analysis of Randomized Control Trials. Ann Surg Oncol 2025; 32:1236-1247. [PMID: 39616295 DOI: 10.1245/s10434-024-16527-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 10/30/2024] [Indexed: 01/16/2025]
Abstract
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.
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Affiliation(s)
- Natalie Hann Soh
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
| | | | - Xi Zhi Low
- Duke-NUS Medical School, Singapore, Singapore
| | - Hanis Abdul Kadir
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
| | - Wei Jing Fong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
| | - Mothi Babu Ramalingam
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Pei Ling Tan
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Kennedy Yao Yi Ng
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Division of Population Health and Integrated Care, Singapore General Hospital, Singapore, Singapore
| | - Ya Ting Hsing
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Mingzhe Cai
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
| | - Chin Jin Seo
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
| | - Johnny Chin-Ann Ong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
- Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore, Singapore
| | - Claramae S Chia
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
| | - Jolene Si Min Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore & Singapore General Hospital, Singapore, Singapore.
- SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
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11
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Randall IM, Au D, Sibley D, Matthew AG, Chen M, Brahmbhatt P, Mach C, Sellers D, Alibhai SMH, Clarke H, Darling G, McCluskey SA, McKinney L, Ng K, Quereshy F, Karkouti K, Santa Mina D. Starting a surgical prehabilitation program: results from a pragmatic nonrandomized feasibility study. Can J Anaesth 2025; 72:162-172. [PMID: 39505763 DOI: 10.1007/s12630-024-02861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 11/08/2024] Open
Abstract
PURPOSE We sought to assess the feasibility and estimate the effects on outcomes of a multimodal prehabilitation service implemented as an ancillary surgical service. METHODS We conducted a pragmatic, nonrandomized feasibility study of surgical prehabilitation. Patients were eligible if they were ≥ 18 yr of age, fluent in English, and referred by a health professional for prehabilitation. Participants received an individualized program of preoperative exercise, nutrition, psychological, and/or smoking cessation support. The primary outcome was operational feasibility, including referral volume, enrolment rate, prehabilitation window, engagement, completion rate, and safety. Secondary outcomes included surgical complications, length of hospital stay, readmission, quality of life, and physical and mental health. Qualitative data related to intervention feasibility and acceptability. We compared intervention participants with patients who were referred for, but declined, prehabilitation. RESULTS One hundred and sixteen patients were referred for prehabilitation. The mean age of referred patients was 71 yr and 55% were male. Over 90% of referrals were from surgical oncology, and the most common indication for referral was frailty (46%). Of the 116 referred patients, 83 consented to participate in the study. Patient-reported and objectively measured outcomes improved by a clinically important margin from baseline to presurgery, and returned to presurgery levels by 90 days postoperatively. Qualitative findings suggest that the prehabilitation intervention was well received. CONCLUSION Multimodal surgical prehabilitation is feasible as an integrated clinical service and may be effective for improving physical and psychological outcomes. Further evaluations of clinically integrated prehabilitation programs in Canada are needed to confirm these findings.
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Affiliation(s)
- Ian M Randall
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Darren Au
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Daniel Sibley
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Andrew G Matthew
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Maggie Chen
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Priya Brahmbhatt
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Calvin Mach
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Daniel Sellers
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gail Darling
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Stuart A McCluskey
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura McKinney
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
| | - Karen Ng
- Department of Geriatrics, Sinai Health System, Toronto, ON, Canada
| | - Fayez Quereshy
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Department of Anesthesia and Pain Management, University Health Network, Toronto, ON, Canada.
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord St., Toronto, ON, M5S 2W6, Canada.
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12
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Chanan EL, Wagener G, Whitlock EL, Berger JC, McAdams-DeMarco MA, Yeh JS, Nunnally ME. Perioperative Considerations in Older Kidney and Liver Transplant Recipients: A Review. Transplantation 2024; 108:e346-e356. [PMID: 38557579 PMCID: PMC11442682 DOI: 10.1097/tp.0000000000005000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
With the growth of the older adult population, the number of older adults waitlisted for and undergoing kidney and liver transplantation has increased. Transplantation is an important and definitive treatment for this population. We present a contemporary review of the unique preoperative, intraoperative, and postoperative issues that patients older than 65 y face when they undergo kidney or liver transplantation. We focus on geriatric syndromes that are common in older patients listed for kidney or liver transplantation including frailty, sarcopenia, and cognitive dysfunction; discuss important considerations for older transplant recipients, which may impact preoperative risk stratification; and describe unique challenges in intraoperative and postoperative management for older patients. Intraoperative challenges in the older adult include using evidence-based best anesthetic practices, maintaining adequate perfusion pressure, and using minimally invasive surgical techniques. Postoperative concerns include controlling acute postoperative pain; preventing cardiovascular complications and delirium; optimizing immunosuppression; preventing perioperative kidney injury; and avoiding nephrotoxicity and rehabilitation. Future studies are needed throughout the perioperative period to identify interventions that will improve patients' preoperative physiologic status, prevent postoperative medical complications, and improve medical and patient-centered outcomes in this vulnerable patient population.
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Affiliation(s)
- Emily L Chanan
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Gebhard Wagener
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
| | - Elizabeth L Whitlock
- Department of Anesthesia & Perioperative Care, University of California, San Francisco, San Francisco, CA
| | - Jonathan C Berger
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
| | - Mara A McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Joseph S Yeh
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
| | - Mark E Nunnally
- Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York, NY
- Department of Surgery, NYU Grossman School of Medicine, New York, NY
- Department of Neurology, NYU Grossman School of Medicine, New York, NY
- Department of Medicine, NYU Grossman School of Medicine, New York, NY
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13
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Feng D, Han D, Li M, Li H, Li N, Liu T, Wang J. Protein nutritional support: The prevention and regulation of colorectal cancer and its mechanism research. FOOD FRONTIERS 2024; 5:2515-2532. [DOI: 10.1002/fft2.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025] Open
Abstract
AbstractColorectal cancer (CRC) is a common malignant tumor of the digestive tract in China; its incidence rates and mortality rates have been on the rise in recent years, ranking third in terms of incidence and second in mortality. Rational dietary intervention plays an important role in human health, and prevention and adjuvant treatment of CRC through dietary supplementation is the most ideal and safest way to treat the disease at present. More importantly, dietary protein is the basis of our diet and the key nutrient to maintain the normal function of the human body. Therefore, this narrative review delivered an overview of the common causes and therapeutic treatments for CRC. It emphasized the importance of dietary interventions, with a particular focus on elucidating the distinct regulatory impacts of plant proteins, animal proteins, and their mixed proteins.
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Affiliation(s)
- Duo Feng
- Institute of Food and Nutrition Development Ministry of Agriculture and Rural Affairs Beijing China
| | - Di Han
- Institute of Food and Nutrition Development Ministry of Agriculture and Rural Affairs Beijing China
| | - Mengjie Li
- Institute of Food and Nutrition Development Ministry of Agriculture and Rural Affairs Beijing China
| | - Hu Li
- Institute of Food and Nutrition Development Ministry of Agriculture and Rural Affairs Beijing China
| | - Na Li
- Institute of Food and Nutrition Development Ministry of Agriculture and Rural Affairs Beijing China
| | - Tianxin Liu
- Institute of Food and Nutrition Development Ministry of Agriculture and Rural Affairs Beijing China
| | - Jing Wang
- Institute of Food and Nutrition Development Ministry of Agriculture and Rural Affairs Beijing China
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14
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Zhou L, Li H, Zhang Z, Wang L. Effects of multimodal prehabilitation and exercise prehabilitation on patients undergoing colorectal surgery: A systematic review and meta-analysis of randomised controlled trials. J Glob Health 2024; 14:04239. [PMID: 39451060 PMCID: PMC11505574 DOI: 10.7189/jogh.14.04239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2024] Open
Abstract
Background Multimodal prehabilitation and exercise prehabilitation are important processes for patients undergoing colorectal surgery. There are no reviews simultaneously analysing the effects of both types of prehabilitation for patients undergoing colorectal surgery. Methods We searched PubMed, Embase, Scopus, Web of Science, the Cochrane Library, ProQuest, and CINAHL Plus with Full Text for relevant randomised controlled trials on multimodal prehabilitation and exercise prehabilitation. The primary outcomes in our meta-analysis were functional capacity, hospital length of stay, postoperative complications, anxiety, and depression scores. Results We included 17 studies involving 1961 for colorectal surgery patients. The results of the meta-analysis suggested that multimodal prehabilitation could improve functional capacity (the 6-minute walk test) in patients undergoing colorectal surgery (mean difference (MD) = 29.00; 95% confidence interval (CI) = 26.64-31.36). In the subgroup analysis, multimodal prehabilitation improved functional capacity only preoperatively (MD = 34.77; 95% CI = 16.76-52.77) and did not improve the length of stay, postoperative complication, and anxiety and depression scores. Exercise prehabilitation did not show a positive effect on functional capacity, the length of stay, postoperative complication, and anxiety and depression scores. Conclusions Compared with exercise prehabilitation, multimodal prehabilitation was more likely improve the functional ability of patients undergoing colorectal surgery. Besides, the effects of multimodal prehabilitation or exercise prehabilitation on the length of stay, postoperative complications and anxiety and depression scores of colorectal surgery patients were not found. Registration PROSPERO: CRD42023453438.
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Affiliation(s)
- Lu Zhou
- Department of Nursing, Peking University People’s Hospital, Beijing, China
- School of Nursing, Peking University, Beijing, China
| | - Hui Li
- Department of Nursing, Peking University People’s Hospital, Beijing, China
- School of Nursing, Peking University, Beijing, China
| | - Zhengyang Zhang
- Department of Nursing, Peking University People’s Hospital, Beijing, China
- School of Nursing, Peking University, Beijing, China
| | - Ling Wang
- Department of Nursing, Peking University People’s Hospital, Beijing, China
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15
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Sebio-Garcia R, Celada-Castro C, Arguis MJ, Sisó M, Torné A, Tena B, Díaz-Feijoo B, Martinez-Palli G. Multimodal prehabilitation improves functional capacity in patients with advanced ovarian cancer undergoing cytoreductive surgery. Int J Gynecol Cancer 2024:ijgc-2024-005686. [PMID: 39375165 DOI: 10.1136/ijgc-2024-005686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2024] Open
Abstract
OBJECTIVE Prehabilitation, defined as the preparatory intervention to increase patient preparedness in the lead-up to surgery, has shown a decrease in post-operative complications in various types of surgery. However, there is limited evidence in advanced ovarian cancer surgery. This study aimed to evaluate the benefits of multimodal prehabilitation in advanced ovarian cancer patients in terms of improving physical functioning, body composition, and psychological well-being during the pre-operative period. METHODS This single-center, ambispective study included patients with advanced ovarian cancer eligible for primary or interval cytoreductive surgery. Participants attended a multimodal prehabilitation program comprising medical optimization, supervised exercise training, nutritional counseling and supplementation, and psychological support. Functional capacity, nutritional status, and psychological well-being were assessed before the start of the program and before surgery. RESULTS 62 patients were referred for the multimodal prehabilitation program from July 2019 to May 2023. Median adherence to the training program reached 75% (IQR 58-87%). 35 patients (59%) were evaluated pre-operatively. Patients attended a median of 8 (IQR 6-12) supervised exercise training sessions with no differences between those who underwent primary or interval cytoreductive surgery (p=0.80). A significant improvement was observed in functional capacity according to the 6 min walk test (mean 33.1 m, 95% CI 10.5 to 55.5) as well as in the 30 s sit-to-stand test (+3.3 repetitions, 95% CI 1.8 to 4.8), with both being above the minimal clinically important difference of 14 m and two repetitions, respectively. Patients also reported a significant decrease in depression, anxiety, and total scores of the Hospital Anxiety and Depression Scale. CONCLUSIONS Multimodal prehabilitation in patients with advanced ovarian cancer undergoing cytoreductive surgery improves pre-operative physical functioning and decreases emotional distress. Further controlled studies with a larger sample size are warranted to corroborate improvement in functional capacity, body composition, and psychological well-being through prehabilitation programs.
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Affiliation(s)
- Raquel Sebio-Garcia
- Department of Rehabilitation, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | | | - Maria J Arguis
- Anaesthesiology and Intensive Care, Hospital Clinic de Barcelona, Barcelona, Spain
- IDIBAPS, Barcelona, Catalunya, Spain
| | - Marina Sisó
- Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Aureli Torné
- Gynecology Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- University of Barcelona. IDIBAPS, Barcelona, Spain
| | - Beatriz Tena
- Anaesthesiology and Intensive Care, Hospital Clinic de Barcelona, Barcelona, Spain
- Universidad de Barcelona, Barcelona, Spain
| | - Berta Díaz-Feijoo
- Gynecology Oncology Unit, Hospital Clínic de Barcelona, Barcelona, Spain
- University of Barcelona. IDIBAPS, Barcelona, Spain
| | - Graciela Martinez-Palli
- Anaesthesiology and Intensive Care, Hospital Clinic de Barcelona, Barcelona, Spain
- IDIBAPS, Barcelona, Catalunya, Spain
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16
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Fleurent-Grégoire C, Burgess N, McIsaac DI, Chevalier S, Fiore JF, Carli F, Levett D, Moore J, Grocott MP, Copeland R, Edbrooke L, Engel D, Testa GD, Denehy L, Gillis C. Towards a common definition of surgical prehabilitation: a scoping review of randomised trials. Br J Anaesth 2024; 133:305-315. [PMID: 38677949 PMCID: PMC11282475 DOI: 10.1016/j.bja.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND There is no universally accepted definition for surgical prehabilitation. The objectives of this scoping review were to (1) identify how surgical prehabilitation is defined across randomised controlled trials and (2) propose a common definition. METHODS The final search was conducted in February 2023 using MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, and Cochrane. We included randomised controlled trials (RCTs) of unimodal or multimodal prehabilitation interventions (nutrition, exercise, and psychological support) lasting at least 7 days in adults undergoing elective surgery. Qualitative data were analysed using summative content analysis. RESULTS We identified 76 prehabilitation trials of patients undergoing abdominal (n=26, 34%), orthopaedic (n=20, 26%), thoracic (n=14, 18%), cardiac (n=7, 9%), spinal (n=4, 5%), and other (n=5, 7%) surgeries. Surgical prehabilitation was explicitly defined in more than half of these RCTs (n=42, 55%). Our findings consolidated the following definition: 'Prehabilitation is a process from diagnosis to surgery, consisting of one or more preoperative interventions of exercise, nutrition, psychological strategies and respiratory training, that aims to enhance functional capacity and physiological reserve to allow patients to withstand surgical stressors, improve postoperative outcomes, and facilitate recovery.' CONCLUSIONS A common definition is the first step towards standardisation, which is needed to guide future high-quality research and advance the field of prehabilitation. The proposed definition should be further evaluated by international stakeholders to ensure that it is comprehensive and globally accepted.
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Affiliation(s)
- Chloé Fleurent-Grégoire
- School of Human Nutrition, McGill University, Montréal, QC, Canada; Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Nicola Burgess
- Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Montréal, QC, Canada; Research Institute of the McGill University Health Centre, Montréal, QC, Canada; Department of Medicine, McGill University, Montréal, QC, Canada
| | - Julio F Fiore
- Department of Surgery, McGill University, Montréal, QC, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University, Montréal, QC, Canada
| | - Denny Levett
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK
| | - John Moore
- Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael P Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton-University of Southampton, Southampton, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield UK
| | - Lara Edbrooke
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montréal, QC, Canada; Department of Surgery, McGill University, Montréal, QC, Canada; Department of Anesthesia, McGill University, Montréal, QC, Canada.
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17
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Ljungqvist O, Weimann A, Sandini M, Baldini G, Gianotti L. Contemporary Perioperative Nutritional Care. Annu Rev Nutr 2024; 44:231-255. [PMID: 39207877 DOI: 10.1146/annurev-nutr-062222-021228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Over the last decades, surgical complication rates have fallen drastically. With the introduction of new surgical techniques coupled with specific evidence-based perioperative care protocols, patients today run half the risk of complications compared with traditional care. Many patients who in previous years needed weeks of hospital care now recover and can leave in days. These remarkable improvements are achieved by using nutritional stress-reducing care elements for the surgical patient that reduce metabolic stress and allow for the return of gut function. This new approach to nutritional care and how it is delivered as an integral part of enhancing recovery after surgery are outlined in this review. We also summarize the new and increased understanding of the effects of the routes of delivering nutrition and the role of the gut, as well as the current recommendations for artificial nutritional support.
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Affiliation(s)
- Olle Ljungqvist
- Department of Surgery, School of Medical Sciences, Orebro University Hospital and Orebro University, Orebro, Sweden;
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Arved Weimann
- Department of General, Visceral, and Oncologic Surgery, Saint George Hospital, Leipzig, Germany
| | - Marta Sandini
- Department of Medicine, Surgery, and Neuroscience and Unit of General and Oncologic Surgery, University of Siena, Siena, Italy
| | - Gabriele Baldini
- Section of Anesthesia and Critical Care, Department of Anesthesia and Critical Care, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Luca Gianotti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- HPB Surgery, Foundation IRCCS San Gerardo Hospital, Monza, Italy
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18
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Amirkhosravi F, Allenson KC, Moore LW, Kolman JM, Foster M, Hsu E, Sasangohar F, Dhala A. Multimodal prehabilitation and postoperative outcomes in upper abdominal surgery: systematic review and meta-analysis. Sci Rep 2024; 14:16012. [PMID: 38992072 PMCID: PMC11239889 DOI: 10.1038/s41598-024-66633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/03/2024] [Indexed: 07/13/2024] Open
Abstract
The impact of multimodal prehabilitation on postoperative complications in upper abdominal surgeries is understudied. This review analyzes randomized trials on multimodal prehabilitation with patient and hospital outcomes. MEDLINE, Embase, CINAHL, and Cochrane CENTRAL were searched for trials on prehabilitation before elective (non-emergency) abdominal surgery. Two reviewers independently screened studies, extracted data, and assessed study quality. Primary outcomes of interest were postoperative pulmonary complications (PPCs) and all-cause complications; secondary outcomes included hospital and intensive care length of stay. A meta-analysis with random-effect models was performed, and heterogeneity was evaluated with I-square and Cochran's Q test. Dichotomous variables were reported in log-odds ratio and continuous variables were presented as mean difference. Ten studies (total 1503 patients) were included. Odds of developing complications after prehabilitation were significantly lower compared to various control groups (- 0.38 [- 0.75- - 0.004], P = 0.048). Five studies described PPCs, and participants with prehabilitation had decreased odds of PPC (- 0.96 [- 1.38- - 0.54], P < 0.001). Prehabilitation did not significantly reduce length of stay, unless exercise was implemented; with exercise, hospital stay decreased significantly (- 0.91 [- 1.67- - 0.14], P = 0.02). Multimodal prehabilitation may decrease complications in upper abdominal surgery, but not necessarily length of stay; research should address heterogeneity in the literature.
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Affiliation(s)
| | | | - Linda W Moore
- Department of Surgery, Houston Methodist, Houston, TX, USA
| | - Jacob M Kolman
- Office of Faculty and Research Development, Department of Academic Affairs, Houston Methodist, Houston, TX, USA
| | - Margaret Foster
- School of Medicine, Department of Medical Education, Texas A&M University, College Station, TX, USA
| | - Enshuo Hsu
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, USA
| | - Farzan Sasangohar
- Wm Michael Barnes '64 Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX, USA
- Center for Critical Care, Houston Methodist, Houston, TX, USA
| | - Atiya Dhala
- Department of Surgery, Houston Methodist, Houston, TX, USA.
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19
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Fleurent-Grégoire C, Burgess N, Denehy L, Edbrooke L, Engel D, Testa GD, Fiore JF, McIsaac DI, Chevalier S, Moore J, Grocott MP, Copeland R, Levett D, Scheede-Bergdahl C, Gillis C. Outcomes reported in randomised trials of surgical prehabilitation: a scoping review. Br J Anaesth 2024; 133:42-57. [PMID: 38570300 PMCID: PMC11213997 DOI: 10.1016/j.bja.2024.01.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/09/2024] [Accepted: 01/29/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Heterogeneity of reported outcomes can impact the certainty of evidence for prehabilitation. The objective of this scoping review was to systematically map outcomes and assessment tools used in trials of surgical prehabilitation. METHODS MEDLINE, EMBASE, PsychInfo, Web of Science, CINAHL, and Cochrane were searched in February 2023. Randomised controlled trials of unimodal or multimodal prehabilitation interventions (nutrition, exercise, psychological support) lasting at least 7 days in adults undergoing elective surgery were included. Reported outcomes were classified according to the International Society for Pharmacoeconomics and Outcomes Research framework. RESULTS We included 76 trials, mostly focused on abdominal or orthopaedic surgeries. A total of 50 different outcomes were identified, measured using 184 outcome assessment tools. Observer-reported outcomes were collected in 86% of trials (n=65), with hospital length of stay being most common. Performance outcomes were reported in 80% of trials (n=61), most commonly as exercise capacity assessed by cardiopulmonary exercise testing. Clinician-reported outcomes were included in 78% (n=59) of trials and most frequently included postoperative complications with Clavien-Dindo classification. Patient-reported outcomes were reported in 76% (n=58) of trials, with health-related quality of life using the 36- or 12-Item Short Form Survey being most prevalent. Biomarker outcomes were reported in 16% of trials (n=12) most commonly using inflammatory markers assessed with C-reactive protein. CONCLUSIONS There is substantial heterogeneity in the reporting of outcomes and assessment tools across surgical prehabilitation trials. Identification of meaningful outcomes, and agreement on appropriate assessment tools, could inform the development of a prehabilitation core outcomes set to harmonise outcome reporting and facilitate meta-analyses.
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Affiliation(s)
- Chloé Fleurent-Grégoire
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Nicola Burgess
- Department of Physiotherapy, Austin Health, Melbourne, VIC, Australia
| | - Linda Denehy
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lara Edbrooke
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia; Department of Health Services Research, The Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Giuseppe Dario Testa
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Julio F Fiore
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Daniel I McIsaac
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Research Institute of the McGill University Health Centre, Montreal, QC, Canada; Department of Medicine, McGill University, Montreal, QC, Canada
| | - John Moore
- Department of Anaesthesia, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael P Grocott
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton - University of Southampton, Southampton, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Denny Levett
- Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton - University of Southampton, Southampton, UK
| | - Celena Scheede-Bergdahl
- Department of Kinesiology and Physical Education, McGill Research, Centre for Physical Activity & Health, McGill University, Montreal, QC, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; Department of Anesthesia, McGill University, Montreal, QC, Canada.
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20
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Jankowski PP, Tretiakov PS, Onafowokan OO, Das A, Imbo B, Krol O, Joujon-Roche R, Williamson T, Dave P, Mir J, Owusu-Sarpong S, Passias PG. Assessing the effects of prehabilitation protocols on post-operative outcomes in adult cervical deformity surgery: does early optimization lead to optimal clinical outcomes? Spine Deform 2024; 12:1107-1113. [PMID: 38538932 DOI: 10.1007/s43390-024-00845-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/13/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE To investigate the effect of a prehabilitation program on peri- and post-operative outcomes in adult cervical deformity (CD) surgery. METHODS Operative CD patients ≥ 18 years with complete baseline (BL) and 2-year (2Y) data were stratified by enrollment in a prehabilitation program beginning in 2019. Patients were stratified as having undergone prehabilitation (Prehab+) or not (Prehab-). Differences in pre and post-op factors were assessed via means comparison analysis. Costs were calculated using PearlDiver database estimates from Medicare pay-scales. RESULTS 115 patients were included (age: 61 years, 70% female, BMI: 28 kg/m2). Of these patients, 57 (49%) were classified as Prehab+. At baseline, groups were comparable in age, gender, BMI, CCI, and frailty. Surgically, Prehab+ were able to undergo longer procedures (p = 0.017) with equivalent EBL (p = 0.627), and shorter SICU stay (p < 0.001). Post-operatively, Prehab+ patients reported greater reduction in pain scores and greater improvement in quality of life metrics at both 1Y and 2Y than Prehab- patients (all p < 0.05). Prehab+ patients reported significantly less complications overall, as well as less need for reoperation (all p < 0.05). CONCLUSION Introducing prehabilitation protocols in adult cervical deformity surgery may aid in improving patient physiological status, enabling patients to undergo longer surgeries with lessened risk of peri- and post-operative complications.
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Affiliation(s)
| | - Peter S Tretiakov
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Oluwatobi O Onafowokan
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Ankita Das
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Bailey Imbo
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Oscar Krol
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Rachel Joujon-Roche
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Tyler Williamson
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Pooja Dave
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Jamshaid Mir
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Stephane Owusu-Sarpong
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Peter G Passias
- Division of Spine, Department of Orthopedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
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21
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Fiorindi C, Giudici F, Testa GD, Foti L, Romanazzo S, Tognozzi C, Mansueto G, Scaringi S, Cuffaro F, Nannoni A, Soop M, Baldini G. Multimodal Prehabilitation for Patients with Crohn's Disease Scheduled for Major Surgery: A Narrative Review. Nutrients 2024; 16:1783. [PMID: 38892714 PMCID: PMC11174506 DOI: 10.3390/nu16111783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/25/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024] Open
Abstract
Approximately 15-50% of patients with Crohn's disease (CD) will require surgery within ten years following the diagnosis. The management of modifiable risk factors before surgery is essential to reduce postoperative complications and to promote a better postoperative recovery. Preoperative malnutrition reduced functional capacity, sarcopenia, immunosuppressive medications, anemia, and psychological distress are frequently present in CD patients. Multimodal prehabilitation consists of nutritional, functional, medical, and psychological interventions implemented before surgery, aiming at optimizing preoperative status and improve postoperative recovery. Currently, studies evaluating the effect of multimodal prehabilitation on postoperative outcomes specifically in CD are lacking. Some studies have investigated the effect of a single prehabilitation intervention, of which nutritional optimization is the most investigated. The aim of this narrative review is to present the physiologic rationale supporting multimodal surgical prehabilitation in CD patients waiting for surgery, and to describe its main components to facilitate their adoption in the preoperative standard of care.
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Affiliation(s)
- Camilla Fiorindi
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Francesco Giudici
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 6, 50135 Florence, Italy; (F.G.); (S.S.)
| | - Giuseppe Dario Testa
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Division of Geriatric and Intensive Care Medicine, University of Florence, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy
| | - Lorenzo Foti
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Section of Anesthesiology and Intensive Care, University of Florence, Largo Brambilla 3, 50139 Florence, Italy
| | - Sara Romanazzo
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Cristina Tognozzi
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Giovanni Mansueto
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
| | - Stefano Scaringi
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 6, 50135 Florence, Italy; (F.G.); (S.S.)
| | - Francesca Cuffaro
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
| | - Anita Nannoni
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
| | - Mattias Soop
- Department for IBD and Intestinal Failure Surgery, Karolinska University Hospital, SE 177 76 Stockholm, Sweden;
| | - Gabriele Baldini
- Department of Health Science, University of Firenze, Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50139 Florence, Italy; (S.R.); (C.T.); (G.M.); (F.C.); (A.N.); (G.B.)
- Multimodal Prehabilitation Center, Azienda Ospedaliera Universitaria Careggi, Largo Brambilla 6, 50135 Florence, Italy; (G.D.T.); (L.F.)
- Section of Anesthesiology and Intensive Care, University of Florence, Largo Brambilla 3, 50139 Florence, Italy
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Ramani A, Hazra T, Mudgil S, Mudgil D. Emerging potential of whey proteins in prevention of cancer. FOOD AND HUMANITY 2024; 2:100199. [DOI: 10.1016/j.foohum.2023.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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23
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Coca-Martinez M, Carli F. Prehabilitation: Who can benefit? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106979. [PMID: 37451924 DOI: 10.1016/j.ejso.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 05/29/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
Prehabilitation is an intervention that occurs between cancer diagnosis and the start of an acute treatment. It involves physical, nutritional, and psychological assessments to establish a baseline functional level and provide targeted interventions to improve a person's health and prevent future impairments. Prehabilitation has been applied to surgical oncology and has shown positive results at improving functional capacity, reducing hospital stay, decreasing complications, and enhancing health-related quality of life. The importance of collaboration between various healthcare professionals and the implementation of multimodal interventions, including exercise training, nutrition optimization, and emotional support is discussed in this manuscript. The need for screening and assessment of conditions such as sarcopenia, frailty, or low functional status in order to identify patients who would benefit the most from prehabilitation is vital and should be a part of all prehabilitation programs. Exercise and nutrition play complementary roles in prehabilitation, enhancing anabolism and performance. However, in the presence of malnutrition and sarcopenia, exercise-related energy expenditure without sufficient protein intake can lead to muscle wasting and further deterioration of functional capacity, thus special emphasis on nutrition and protein intake should be made in these cases. Finally, the challenges and the need for a paradigm shift in perioperative care are discussed to effectively implement personalized prehabilitation programs.
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Affiliation(s)
- Miquel Coca-Martinez
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada; Department of Anesthesia and Intensive Care, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Franco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada.
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24
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McKechnie T, Saddik M, Doumouras A, Eskicioglu C, Parpia S, Bhandari M. PREscribing preoperative weight loss prior to major non-bariatric abdominal surgery for patients with Elevated weight: Patient and Provider Survey Protocols (PREPARE surveys). PLoS One 2024; 19:e0302482. [PMID: 38687754 PMCID: PMC11060585 DOI: 10.1371/journal.pone.0302482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Preoperative very low energy diet (VLED) interventions are used routinely in patients undergoing bariatric surgery, a surgical subspecialty that deals almost exclusively with patients with obesity. Yet, their use and study has been limited in non-bariatric abdominal surgery. To investigate the use of VLEDs in non-bariatric surgery, we plan on conducting a randomized controlled trial (RCT). Prior to proceeding, however, we have designed two surveys as important pre-emptive studies aimed at elucidating patient and provider perspectives regarding these interventions. METHODS The patient survey is a cross-sectional, single-center survey aimed at assessing the safety, adherence, barriers to adherence, and willingness to participate in preoperative optimization protocols with VLEDs prior to undergoing elective non-bariatric intra-abdominal surgery (S1 File). The population of interest is all adult patients with obesity undergoing elective non-bariatric intra-abdominal surgery at St. Joseph's Healthcare Hamilton who were prescribed a course of preoperative VLED. The primary outcomes will be safety and adherence. The target sample size is 35 survey responses. The provider survey is a cross-sectional national survey of practicing surgeons in Canada who perform major non-bariatric abdominal surgery aimed assessing the willingness and ability to prescribe preoperative weight loss interventions amongst practicing Canadian surgeons who perform major non-bariatric abdominal surgery (S2 File). The population of interest is independent practicing surgeons in Canada who perform major non-bariatric abdominal surgery. The primary outcome will be willingness to prescribe preoperative VLED to patients with obesity undergoing major non-bariatric abdominal surgery for both benign and malignant indications. The target sample size is 61 survey responses. Descriptive statistics will be used to characterize the sample populations. To determine variables associated with primary outcomes in the surveys, regression analyses will be performed. DISCUSSION These survey data will ultimately inform the design of an RCT evaluating the efficacy of preoperative VLEDs for patients with obesity undergoing major abdominal surgery.
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Affiliation(s)
- Tyler McKechnie
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Maisa Saddik
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Aristithes Doumouras
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Division of General Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Division of General Surgery, St. Joseph Healthcare, Hamilton, Ontario, Canada
| | - Sameer Parpia
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, Division of Orthopedic Surgery, McMaster University, Hamilton, Ontario, Canada
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25
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Sowerbutts AM, Burden S, Sremanakova J, French C, Knight SR, Harrison EM. Preoperative nutrition therapy in people undergoing gastrointestinal surgery. Cochrane Database Syst Rev 2024; 4:CD008879. [PMID: 38588454 PMCID: PMC11001290 DOI: 10.1002/14651858.cd008879.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Poor preoperative nutritional status has been consistently linked to an increase in postoperative complications and worse surgical outcomes. We updated a review first published in 2012. OBJECTIVES To assess the effects of preoperative nutritional therapy compared to usual care in people undergoing gastrointestinal surgery. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, three other databases and two trial registries on 28 March 2023. We searched reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) of people undergoing gastrointestinal surgery and receiving preoperative nutritional therapy, including parenteral nutrition, enteral nutrition or oral nutrition supplements, compared to usual care. We only included nutritional therapy that contained macronutrients (protein, carbohydrate and fat) and micronutrients, and excluded studies that evaluated single nutrients. We included studies regardless of the nutritional status of participants, that is, well-nourished participants, participants at risk of malnutrition, or mixed populations. We excluded studies in people undergoing pancreatic and liver surgery. Our primary outcomes were non-infectious complications, infectious complications and length of hospital stay. Our secondary outcomes were nutritional aspects, quality of life, change in macronutrient intake, biochemical parameters, 30-day perioperative mortality and adverse effects. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. We assessed risk of bias using the RoB 1 tool and applied the GRADE criteria to assess the certainty of evidence. MAIN RESULTS We included 16 RCTs reporting 19 comparisons (2164 participants). Seven studies were new for this update. Participants' ages ranged from 21 to 79 years, and 62% were men. Three RCTs used parenteral nutrition, two used enteral nutrition, eight used immune-enhancing nutrition and six used standard oral nutrition supplements. All studies included mixed groups of well-nourished and malnourished participants; they used different methods to identify malnutrition and reported this in different ways. Not all the included studies were conducted within an Enhanced Recovery After Surgery (ERAS) programme, which is now current clinical practice in most hospitals undertaking GI surgery. We were concerned about risk of bias in all the studies and 14 studies were at high risk of bias due to lack of blinding. We are uncertain if parenteral nutrition has any effect on the number of participants who had a non-infectious complication (risk ratio (RR) 0.61, 95% confidence interval (CI) 0.36 to 1.02; 3 RCTs, 260 participants; very low-certainty evidence); infectious complication (RR 0.98, 95% CI 0.53 to 1.80; 3 RCTs, 260 participants; very low-certainty evidence) or length of hospital stay (mean difference (MD) 5.49 days, 95% CI 0.02 to 10.96; 2 RCTs, 135 participants; very low-certainty evidence). None of the enteral nutrition studies reported non-infectious complications as an outcome. The evidence is very uncertain about the effect of enteral nutrition on the number of participants with infectious complications after surgery (RR 0.90, 95% CI 0.59 to 1.38; 2 RCTs, 126 participants; very low-certainty evidence) or length of hospital stay (MD 5.10 days, 95% CI -1.03 to 11.23; 2 RCTs, 126 participants; very low-certainty evidence). Immune-enhancing nutrition compared to controls may result in little to no effect on the number of participants experiencing a non-infectious complication (RR 0.79, 95% CI 0.62 to 1.00; 8 RCTs, 1020 participants; low-certainty evidence), infectious complications (RR 0.74, 95% CI 0.53 to 1.04; 7 RCTs, 925 participants; low-certainty evidence) or length of hospital stay (MD -1.22 days, 95% CI -2.80 to 0.35; 6 RCTs, 688 participants; low-certainty evidence). Standard oral nutrition supplements may result in little to no effect on number of participants with a non-infectious complication (RR 0.90, 95% CI 0.67 to 1.20; 5 RCTs, 473 participants; low-certainty evidence) or the length of hospital stay (MD -0.65 days, 95% CI -2.33 to 1.03; 3 RCTs, 299 participants; low-certainty evidence). The evidence is very uncertain about the effect of oral nutrition supplements on the number of participants with an infectious complication (RR 0.88, 95% CI 0.60 to 1.27; 5 RCTs, 473 participants; very low-certainty evidence). Sensitivity analysis based on malnourished and weight-losing participants found oral nutrition supplements may result in a slight reduction in infections (RR 0.58, 95% CI 0.40 to 0.85; 2 RCTs, 184 participants). Studies reported some secondary outcomes, but not consistently. Complications associated with central venous catheters occurred in RCTs involving parenteral nutrition. Adverse events in the enteral nutrition, immune-enhancing nutrition and standard oral nutrition supplements RCTs included nausea, vomiting, diarrhoea and abdominal pain. AUTHORS' CONCLUSIONS We were unable to determine if parenteral nutrition, enteral nutrition, immune-enhancing nutrition or standard oral nutrition supplements have any effect on the clinical outcomes due to very low-certainty evidence. There is some evidence that standard oral nutrition supplements may have no effect on complications. Sensitivity analysis showed standard oral nutrition supplements probably reduced infections in weight-losing or malnourished participants. Further high-quality multicentre research considering the ERAS programme is required and further research in low- and middle-income countries is needed.
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Affiliation(s)
- Anne Marie Sowerbutts
- School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Sorrel Burden
- School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Jana Sremanakova
- School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Chloe French
- School of Health Sciences, The University of Manchester, and Manchester Academic Health Science Centre, Manchester, UK
| | - Stephen R Knight
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
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Ten Cate DWG, Sabajo CR, Molenaar CJL, Janssen L, Bongers BC, Slooter GD. Multimodal prehabilitation in elective oncological colorectal surgery enhances preoperative physical fitness: a single center prospective real-world data analysis. Acta Oncol 2024; 63:35-43. [PMID: 38477370 PMCID: PMC11332481 DOI: 10.2340/1651-226x.2024.20287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/01/2023] [Indexed: 03/14/2024]
Abstract
BACKGROUND Surgery can lead to curation in colorectal cancer (CRC) but is associated with significant morbidity. Prehabilitation plays an important role in increasing preoperative physical fitness to reduce morbidity risk; however, data from real-world practice is scarce. This study aimed to evaluate the change in preoperative physical fitness and to evaluate which patients benefit most from prehabilitation. MATERIALS AND METHODS In this single-arm prospective cohort study, consecutive patients undergoing elective colorectal oncological surgery were offered a 3- to 4-week multimodal prehabilitation program (supervised physical exercise training, dietary consultation, protein and vitamin supplementation, smoking cessation, and psychological support). The primary outcome was the change in preoperative aerobic fitness (steep ramp test (SRT)). Secondary outcomes were the change in functional walking capacity (6-minute walk test (6MWT)), and muscle strength (one-repetition maximum (1RM) for various muscle groups). To evaluate who benefit most from prehabilitation, participants were divided in quartiles (Q1, Q2, Q3, and Q4) based on baseline performance. RESULTS In total, 101 patients participated (51.4% male, aged 69.7 ± 12.7 years). The preoperative change in SRT was +28.3 W, +0.36 W/kg, +16.7% (P<0.001). Patients in all quartiles improved at the group level; however, the relative improvement decreased from Q1-Q2, Q2-Q3, and Q3-Q4 (P=0.049). Change in 6MWT was +37.5 m, +7.7% (P<0.001) and 1RM improved with 5.6-33.2 kg, 16.1-32.5% for the various muscle groups (P<0.001). CONCLUSION Prehabilitation in elective oncological colorectal surgery is associated with enhanced preoperative physical fitness regardless of baseline performance. Improvements were relatively larger in less fit patients.
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Affiliation(s)
- David W G Ten Cate
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB Veldhoven, the Netherlands.
| | - Charissa R Sabajo
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB Veldhoven, the Netherlands
| | - Charlotte J L Molenaar
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB Veldhoven, the Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB Veldhoven, the Netherlands
| | - Bart C Bongers
- Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, 6629 ER Maastricht, the Netherlands; Department of Surgery, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 50, 6629 ER Maastricht, the Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB Veldhoven, the Netherlands
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Kasvis P, Vigano A, Bui T, Carli F, Kilgour RD. Cancer symptom burden negatively affects health-related quality of life in patients undergoing prehabilitation prior to liver resection: results from a 12-week randomized controlled trial. Appl Physiol Nutr Metab 2024; 49:64-76. [PMID: 37690126 DOI: 10.1139/apnm-2023-0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
TAKE HOME MESSAGE Cancer symptoms negatively affect health-related quality of life (HRQoL) in patients with cancer awaiting liver resection. Prehabilitation maintained HRQoL after surgery. Future studies should test whether relieving cancer symptoms can improve HRQoL.
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Affiliation(s)
- Popi Kasvis
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC, Canada
- Supportive and Palliative Care Division, McGill University Health Centre, Montreal, QC, Canada
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Antonio Vigano
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC, Canada
- Supportive and Palliative Care Division, McGill University Health Centre, Montreal, QC, Canada
| | - Tram Bui
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC, Canada
| | - Franco Carli
- Department of Anesthesiology, McGill University Health Centre, Montreal, QC, Canada
| | - Robert D Kilgour
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, QC, Canada
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
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Triguero-Cánovas D, López-Rodríguez-Arias F, Gómez-Martínez M, Sánchez-Guillén L, Peris-Castelló F, Alcaide-Quirós MJ, Morillas-Blasco P, Arroyo A, Ramírez JM. Home-based prehabilitation improves physical conditions measured by ergospirometry and 6MWT in colorectal cancer patients: a randomized controlled pilot study. Support Care Cancer 2023; 31:673. [PMID: 37930478 DOI: 10.1007/s00520-023-08140-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE/BACKGROUND Prehabilitation aims to improve physical condition in the preoperative period and, therefore, decrease the loss of cardiopulmonary capacity postoperatively, with the aim of reducing complications and promoting an early recovery. This study aims to evaluate the impact of home-based prehabilitation on the physical condition of patients treated surgically for colorectal cancer. METHODS A prospective and randomized clinical study was conducted on 60 patients during two periods from October 2018 to February 2019 and from September 2019 to September 2020, in a single university hospital. Patients were randomized into two study groups (30 per group): prehabilitation vs. standard care. Changes in physical condition, measured at diagnosis, the day before surgery, and at 6-8 weeks after surgery using the cardiopulmonary exercise testing (CPET) and the 6-minute walk test (6MWT) were evaluated. RESULTS Prehabilitation reduced postoperative complications (17.4% vs. 33.3%, p = 0.22) and hospital stay (5.74 vs. 6.67 days, p = 0.30). 6MWT showed a significant improvement in the prehabilitation group (+78.9 m). Six weeks after surgery, prehabilitation showed a significant improvement in the 6MWT (+68.9 m vs. -27.2 m, p = 0.01). Significant differences were also observed in the ergospirometry between the diagnosis and postoperative study (+0.79 METs vs. -0.84 METs, p = 0.001). A strong correlation was observed between CPET and 6MWT (0.767 (p < 0.001)). CONCLUSION Home prehabilitation achieved lower overall postoperative complications than standard care and reached significant improvements in 6MWT and CET. A strong correlation was observed between CET and 6MWT, which allows validation of 6MWT as a valid and reliable measure of functional exercise capacity in colorectal patients when other, more specific and expensive tests are not available. TRIAL REGISTRATION Registered in ClinicalTrials.gov in August 2018 with registration number https://clinicaltrials.gov/study/NCT03618329?cond=Prehabilitation%20cancer&term=arroyo&distance=50&rank=1 (NCT03618329). Initial results published in Supportive Care in Cancer: Effect of home-based prehabilitation in an enhanced recovery after surgery program for patients undergoing colorectal cancer surgery during the COVID-19 pandemic. DOI: https://doi.org/10.1007/s00520-021-06343-1 .
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Affiliation(s)
- Daniel Triguero-Cánovas
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Francisco López-Rodríguez-Arias
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Manuel Gómez-Martínez
- Department of Cardiology, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Luis Sánchez-Guillén
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain.
| | - Franc Peris-Castelló
- Department of Cardiology, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - María José Alcaide-Quirós
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Pedro Morillas-Blasco
- Department of Cardiology, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Antonio Arroyo
- Department of General Surgery, Colorectal Unit, Elche University Hospital, University Miguel Hernández of Elche, Alicante, Spain
| | - Jose Manuel Ramírez
- Department of General Surgery, Colorectal Unit, University Hospital Lozano Blesa, University of Zaragoza, Zaragoza, Spain
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Kovoor JG, Nann SD, Barot DD, Garg D, Hains L, Stretton B, Ovenden CD, Bacchi S, Chan E, Gupta AK, Hugh TJ. Prehabilitation for general surgery: a systematic review of randomized controlled trials. ANZ J Surg 2023; 93:2411-2425. [PMID: 37675939 DOI: 10.1111/ans.18684] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/23/2023] [Accepted: 08/27/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Prehabilitation seeks to optimize patient health before surgery to improve outcomes. Randomized controlled trials (RCTs) have been conducted on prehabilitation, however an updated synthesis of this evidence is required across General Surgery to inform potential Supplementary discipline-level protocols. Accordingly, this systematic review of RCTs aimed to evaluate the use of prehabilitation interventions across the discipline of General Surgery. METHODS This study was registered with PROSPERO (CRD42023403289), and adhered to PRISMA 2020 and SWiM guidelines. PubMed/MEDLINE and Ovid Embase were searched to 4 March 2023 for RCTs evaluating prehabilitation interventions within the discipline of General Surgery. After data extraction, risk of bias was assessed using the Cochrane RoB 2 tool. Quantitative and qualitative data were synthesized and analysed. However, meta-analysis was precluded due to heterogeneity across included studies. RESULTS From 929 records, 36 RCTs of mostly low risk of bias were included. 17 (47.2%) were from Europe, and 14 (38.9%) North America. 30 (83.3%) investigated cancer populations. 31 (86.1%) investigated physical interventions, finding no significant difference in 16 (51.6%) and significant improvement in 14 (45.2%). Nine (25%) investigated psychological interventions: six (66.7%) found significant improvement, three (33.3%) found no significant difference. Five (13.9%) investigated nutritional interventions, finding no significant difference in three (60%), and significant improvement in two (40%). CONCLUSIONS Prehabilitation interventions showed mixed levels of effectiveness, and there is insufficient RCT evidence to suggest system-level delivery across General Surgery within standardized protocols. However, given potential benefits and non-inferiority to standard care, they should be considered on a case-by-case basis.
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Affiliation(s)
- Joshua G Kovoor
- University of Sydney, Sydney, New South Wales, Australia
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
| | - Silas D Nann
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Dwarkesh D Barot
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Devanshu Garg
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Lewis Hains
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Brandon Stretton
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher D Ovenden
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Health and Information, Adelaide, South Australia, Australia
- University of Adelaide, Adelaide, South Australia, Australia
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Erick Chan
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Aashray K Gupta
- University of Sydney, Sydney, New South Wales, Australia
- Health and Information, Adelaide, South Australia, Australia
- Gold Coast University Hospital, Gold Coast, Queensland, Australia
- University of Adelaide, Adelaide, South Australia, Australia
| | - Thomas J Hugh
- University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore Hospital, Sydney, New South Wales, Australia
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Engel D, Testa GD, McIsaac DI, Carli F, Santa Mina D, Baldini G, Scheede-Bergdahl C, Chevalier S, Edgar L, Beilstein CM, Huber M, Fiore JF, Gillis C. Reporting quality of randomized controlled trials in prehabilitation: a scoping review. Perioper Med (Lond) 2023; 12:48. [PMID: 37653530 PMCID: PMC10472732 DOI: 10.1186/s13741-023-00338-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Inadequate study reporting precludes interpretation of findings, pooling of results in meta-analyses, and delays knowledge translation. While prehabilitation interventions aim to enhance candidacy for surgery, to our knowledge, a review of the quality of reporting in prehabilitation has yet to be conducted. Our objective was to determine the extent to which randomized controlled trials (RCTs) of prehabilitation are reported according to methodological and intervention reporting checklists. METHODS Eligibility criteria: RCTs of unimodal or multimodal prehabilitation interventions. SOURCES OF EVIDENCE search was conducted in March 2022 using MEDLINE, Embase, PsychINFO, Web of Science, CINAHL, and Cochrane. CHARTING METHODS identified studies were compared to CONSORT, CERT & Modified CERT, TIDieR, PRESENT, and CONSORT-SPI. An agreement ratio (AR) was defined to evaluate if applicable guideline items were correctly reported. Data were analyzed as frequency (n, %) and mean with standard deviation (SD). RESULTS We identified 935 unique articles and included 70 trials published from 1994 to 2022. Most prehabilitation programs comprised exercise-only interventions (n = 40, 57%) and were applied before oncologic surgery (n = 32, 46%). The overall mean AR was 57% (SD: 20.9%). The specific mean ARs were as follows: CONSORT: 71% (SD: 16.3%); TIDieR: 62% (SD:17.7%); CERT: 54% (SD: 16.6%); Modified-CERT: 40% (SD:17.8%); PRESENT: 78% (SD: 8.9); and CONSORT-SPI: 47% (SD: 22.1). CONCLUSION Altogether, existing prehabilitation trials report approximately half of the checklist items recommended by methodological and intervention reporting guidelines. Reporting practices may improve with the development of a reporting checklist specific to prehabilitation interventions.
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Affiliation(s)
- Dominique Engel
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anesthesia, McGill University, Montréal, QC, Canada
| | - Giuseppe Dario Testa
- Department of Anesthesia, McGill University, Montréal, QC, Canada
- Division of Geriatric and Intensive Care Medicine, University of Florence and Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Daniel I McIsaac
- Clinical Epidemiology Program, Department of Anesthesiology and Pain Medicine, Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University, Montréal, QC, Canada
| | - Daniel Santa Mina
- Department of Anesthesia and Pain Management, Faculty of Medicine, Faculty of Kinesiology and Physical Education, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Gabriele Baldini
- Section of Anesthesiology, Intensive Care and Pain Medicine, Anesthesiology and Intensive Care Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Stéphanie Chevalier
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
- Department of Medicine, Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Linda Edgar
- Prehabilitation Clinic, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Christian M Beilstein
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julio F Fiore
- Department of Surgery, McGill University, Montreal, QC, H3G 1A4, Canada
| | - Chelsia Gillis
- Department of Anesthesia, McGill University, Montréal, QC, Canada.
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada.
- Department of Surgery, McGill University, Montreal, QC, H3G 1A4, Canada.
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Molenaar CJ, van Rooijen SJ, Fokkenrood HJ, Roumen RM, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database Syst Rev 2023; 5:CD013259. [PMID: 37162250 PMCID: PMC10171468 DOI: 10.1002/14651858.cd013259.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Surgery is the cornerstone in curative treatment of colorectal cancer. Unfortunately, surgery itself can adversely affect patient health. 'Enhanced Recovery After Surgery' programmes, which include multimodal interventions, have improved patient outcomes substantially. However, these are mainly applied peri- and postoperatively. Multimodal prehabilitation includes multiple preoperative interventions to prepare patients for surgery with the aim of increasing resilience, thereby improving postoperative outcomes. OBJECTIVES To determine the effects of multimodal prehabilitation programmes on functional capacity, postoperative complications, and quality of life in adult patients undergoing surgery for colorectal cancer. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and PsycINFO in January 2021. We also searched trial registries up to March 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) in adult patients with non-metastatic colorectal cancer, scheduled for surgery, comparing multimodal prehabilitation programmes (defined as comprising at least two preoperative interventions) with no prehabilitation. We focused on the following outcomes: functional capacity (i.e. 6-minute walk test, VO2peak, handgrip strength), postoperative outcomes (i.e. complications, mortality, length of hospital stay, emergency department visits, re-admissions), health-related quality of life, compliance, safety of prehabilitation, and return to normal activities. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data, assessed risk of bias and used GRADE to assess the certainty of the evidence. Any disagreements were solved with discussion and consensus. We pooled data to perform meta-analyses, where possible. MAIN RESULTS We included three RCTs that enrolled 250 participants with non-metastatic colorectal cancer, scheduled for elective (mainly laparoscopic) surgery. Included trials were conducted in tertiary care centres and recruited patients during periods ranging from 17 months to 45 months. A total of 130 participants enrolled in a preoperative four-week trimodal prehabilitation programme consisting of exercise, nutritional intervention, and anxiety reduction techniques. Outcomes of these participants were compared to those of 120 participants who started an identical but postoperative programme. Postoperatively, prehabilitation may improve functional capacity, determined with the 6-minute walk test at four and eight weeks (mean difference (MD) 26.02, 95% confidence interval (CI) -13.81 to 65.85; 2 studies; n = 131; and MD 26.58, 95% CI -8.88 to 62.04; 2 studies; n = 140); however, the certainty of evidence is low and very low, respectively, due to serious risk of bias, imprecision, and inconsistency. After prehabilitation, the functional capacity before surgery improved, with a clinically relevant mean difference of 24.91 metres (95% CI 11.24 to 38.57; 3 studies; n = 225). The certainty of evidence was moderate due to downgrading for serious risk of bias. The effects of prehabilitation on the number of complications (RR 0.95, 95% CI 0.70 to 1.29; 3 studies; n = 250), emergency department visits (RR 0.72, 95% CI 0.39 to 1.32; 3 studies; n = 250) and re-admissions (RR 1.20, 95% CI 0.54 to 2.65; 3 studies; n = 250) were small or even trivial. The certainty of evidence was low due to downgrading for serious risk of bias and imprecision. The effects on VO2peak, handgrip strength, length of hospital stay, mortality rate, health-related quality of life, return to normal activities, safety of the programme, and compliance rate could not be analysed quantitatively due to missing or insufficient data. The included studies did not report a difference between groups for health-related quality of life and length of hospital stay. Data on remaining outcomes were not reported or were reported inadequately in the included studies. AUTHORS' CONCLUSIONS Prehabilitation may result in an improved functional capacity, determined with the 6-minute walk test both preoperatively and postoperatively. A solid effect on the number of omplications, postoperative emergency department visits and re-admissions could not be established. The certainty of evidence ranges from moderate to very low, due to downgrading for serious risk of bias, imprecision and inconsistency. In addition, only three heterogeneous studies were included in this review. Therefore, the findings of this review should be interpreted with caution. Numerous relevant RCTs are ongoing and will be included in a future update of this review.
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Affiliation(s)
| | | | | | - Rudi Mh Roumen
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
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Augustyniak A, Gottardi D, Giordani B, Gaffey J, Mc Mahon H. Dairy bioactives and functional ingredients with skin health benefits. J Funct Foods 2023. [DOI: 10.1016/j.jff.2023.105528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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van Exter SH, Drager LD, van Asseldonk MJMD, Strijker D, van der Schoot ND, van den Heuvel B, Verlaan S, van den Berg MGA. Adherence to and Efficacy of the Nutritional Intervention in Multimodal Prehabilitation in Colorectal and Esophageal Cancer Patients. Nutrients 2023; 15:2133. [PMID: 37432252 PMCID: PMC10181115 DOI: 10.3390/nu15092133] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 07/12/2023] Open
Abstract
Multimodal prehabilitation programs to improve physical fitness before surgery often include nutritional interventions. This study evaluates the efficacy of and adherence to a nutritional intervention among colorectal and esophageal cancer patients undergoing the multimodal Fit4Surgery prehabilitation program. The intervention aims to achieve an intake of ≥1.5 g of protein/kg body weight (BW) per day through dietary advice and daily nutritional supplementation (30 g whey protein). This study shows 56.3% of patients met this goal after prehabilitation. Mean daily protein intake significantly increased from 1.20 ± 0.39 g/kg BW at baseline to 1.61 ± 0.41 g/kg BW after prehabilitation (p < 0.001), with the main increase during the evening snack. BW, BMI, 5-CST, and protein intake at baseline were associated with adherence to the nutritional intervention. These outcomes suggest that dietary counseling and protein supplementation can significantly improve protein intake in different patient groups undergoing a multimodal prehabilitation program.
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Affiliation(s)
- Sabien H. van Exter
- Department of Gastro-Enterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Luuk D. Drager
- Department of Operating Rooms, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Monique J. M. D. van Asseldonk
- Department of Gastro-Enterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Dieuwke Strijker
- Department of Surgery, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Nina D. van der Schoot
- Department of Gastro-Enterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Baukje van den Heuvel
- Department of Operating Rooms, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
| | - Sjors Verlaan
- Department of Operating Rooms, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
- FrieslandCampina, 6708 WH Wageningen, The Netherlands
- Faculty of Sports & Nutrition, Amsterdam University of Applied Sciences, 1067 SM Amsterdam, The Netherlands
| | - Manon G. A. van den Berg
- Department of Gastro-Enterology and Hepatology, Dietetics and Intestinal Failure, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
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Miralpeix E, Fabregó B, Rodriguez-Cosmen C, Solé-Sedeño JM, Gayete S, Jara-Bogunya D, Corcoy M, Mancebo G. Prehabilitation in an ERAS program for endometrial cancer patients: impact on post-operative recovery. Int J Gynecol Cancer 2023; 33:528-533. [PMID: 36898697 DOI: 10.1136/ijgc-2022-004130] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVES Enhanced recovery after surgery (ERAS) and prehabilitation programs are multidisciplinary care pathways that aim to reduce stress response and improve perioperative outcomes. However, literature is limited regarding the impact of ERAS and prehabilitation in gynecologic oncology surgery. The aim of this study was to assess the impact of implementing an ERAS and prehabilitation program on post-operative outcomes of endometrial cancer patients undergoing laparoscopic surgery. METHODS We evaluated consecutive patients undergoing laparoscopy for endometrial cancer that followed ERAS and the prehabilitation program at a single center. A pre-intervention cohort that followed the ERAS program alone was identified. The primary outcome was length of stay, and secondary outcomes were normal oral diet restart, post-operative complications and readmissions. RESULTS A total of 128 patients were included: 60 patients in the ERAS group and 68 patients in the prehabilitation group. The prehabilitation group had a shorter length of hospital stay of 1 day (p<0.001) and earlier normal oral diet restart of 3.6 hours (p=0.005) in comparison with the ERAS group. The rate of post-operative complications (5% in the ERAS group and 7.4% in the prehabilitation group, p=0.58) and readmissions (1.7% in the ERAS group and 2.9% in the prehabilitation group, p=0.63) were similar between groups. CONCLUSIONS The integration of ERAS and a prehabilitation program in endometrial cancer patients undergoing laparoscopy significantly reduced hospital stay and time to first oral diet as compared with ERAS alone, without increasing overall complications or the readmissions rate.
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Affiliation(s)
- Ester Miralpeix
- Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Catalunya, Spain
| | - Berta Fabregó
- Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Catalunya, Spain
| | | | | | - Sonia Gayete
- Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Catalunya, Spain
| | - David Jara-Bogunya
- Family and Community Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Marta Corcoy
- Department of Anesthesia, Hospital del Mar, Barcelona, Catalunya, Spain
| | - Gemma Mancebo
- Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona, Catalunya, Spain
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Kasvis P, Vigano A, Bui T, Carli F, Kilgour RD. Impact of Dietary Counseling on Health-Related Quality of Life in Patients with Cancer Awaiting Hepato-Pancreato-Biliary Surgery. Nutr Cancer 2023; 75:1151-1164. [PMID: 36867443 DOI: 10.1080/01635581.2023.2178961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
We examined the effectiveness of dietary counseling performed within a trimodal prehabilitation study for patients with cancer awaiting hepato-pancreato-biliary (HPB) surgery. Additionally, we explored relationships between nutritional status and health-related quality of life (HRQoL). The dietary intervention aimed to achieve a protein intake of 1.5 g/kg/day and reduce nutrition-impact symptoms. Patients received dietary counseling 4 weeks prior to surgery (prehabilitation group); the rehabilitation group just before surgery. We used 3-day food journals to calculate protein intake and the abridged Patient-generated Subjective Global Assessment questionnaire (aPG-SGA) to determine nutritional status. We utilized the Functional Assessment of Cancer Therapy-General questionnaire to measure HRQoL. Sixty-one patients participated in the study (30 = prehabilitation). Dietary counseling achieved a significant increase in preoperative protein intake (+0.3 ± 0.1 g/kg/day, P = 0.007), with no change in the rehabilitation group. Dietary counseling did not mitigate a significant increase in aPG-SGA postoperatively (prehabilitation: +5.8 ± 1.0; rehabilitation: +3.3 ± 1.0; P < 0.05). aPG-SGA was predictive of HRQoL (β = -1.77, P < 0.0001). HRQoL remained unchanged in both groups over the study period. Dietary counseling within a HPB prehabilitation program improves preoperative protein intake, but not aPG-SGA, which is predictive of HRQoL. Future studies should examine whether specialized medical management of nutrition-impact symptoms would improve HRQoL outcomes within a prehabilitation model.
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Affiliation(s)
- Popi Kasvis
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.,Supportive and Palliative Care Division, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Antonio Vigano
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.,Supportive and Palliative Care Division, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tram Bui
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
| | - Franco Carli
- Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada
| | - Robert D Kilgour
- McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, Quebec, Canada.,Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, Quebec, Canada
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[Whey protein and caseinate supplementation in oncological patients undergoing elective surgery for the modification of functional capacity]. NUTR HOSP 2023; 40:257-265. [PMID: 36880717 DOI: 10.20960/nh.04292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
INTRODUCTION the nutritional intervention has become a critical point to achieve the reduction of perioperative morbidity and mortality in cancer patients. There are different factors that will play a fundamental role in the evolution and prognosis of this pathology, being the state of nutrition and diet a cornerstone in these aspects. OBJECTIVE to evaluate the perioperative effect of whey protein isolate (WPI) and calcium caseinate (CaCNT) in cancer patients undergoing elective surgery. METHODS randomized controlled clinical trial with three groups: the control group (n = 15), consisting in conventional management by the oncology surgery services, and two intervention groups, one with calcium caseinate supplementation (n = 15) and another one with whey protein isolate supplementation (n = 15) for six weeks perioperatively. Handgrip strength, six-minute walk, and body composition were assessed pre and postoperatively. RESULTS those who were supplemented with WPI maintained their handgrip strength and showed less extracellular water (p < 0.02); also an increase in visceral mass was shown (p < 0.02). Finally, a correlation was found with variables associated with body composition and patient evolution when compared to the control group. CONCLUSIONS nutritional supplementation needs to be approached from the functional and metabolic point of view to identify factors that have a favorable impact, as well as the distinction between carcinoma and the type of supplementation to be implemented.
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Lee D, Wang A, Augustin B, Buajitti E, Tahasildar B, Carli F, Gillis C. Socioeconomic status influences participation in cancer prehabilitation and preparation for surgical recovery: A pooled retrospective analysis using a validated area-level socioeconomic status metric. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:512-520. [PMID: 36435646 DOI: 10.1016/j.ejso.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Prehabilitation employs exercise, nutrition, and psychological interventions to optimize physiological status in preparation for surgery. First, we described the extent to which material deprivation index score (MDIS) influenced prehabilitation participation. Second, we evaluated the extent to which prehabilitation influenced recovery as compared to control. METHODS Pooled patient records from prospective multimodal prehabilitation studies in oncologic surgery were retrospectively examined. Patient postal codes were linked to their MDIS, a validated area-level socioeconomic status (SES) metric, as quintiles 1-5 (1 = highest SES). Functional capacity was evaluated with the 6-min walking test (6MWT) at baseline, before, and 8 weeks post-surgery. Influence of prehabilitation on length of hospital stay (LOS) was explored using generalized linear models with a negative binomial distribution adjusted for age, sex, surgical population, and MDIS. RESULTS Recruitment records were available from 2014 onwards, yielding 1013 eligible patients for prehabilitation participation with MDIS data. Fewer patients with a low SES enrolled (Q1:62% vs. Q5:47%; P = 0.01) and remained in prehabilitation studies (Q1: 59% vs. Q5: 45%; P = 0.07). Prehabilitation study records were available from 2008 onward, yielding 886 enrolled patients with MDIS data (n = 510 prehabilitation, n = 376 control). Preoperative 6MWT similarly improved by > 20 m in response to prehabilitation across SES strata (P < 0.05). Postoperative 6MWT could not be evaluated due to substantial missing data. Prehabilitation had a significant protective influence on LOS, as compared to control, in unadjusted and adjusted models [adjusted IRR:0.77 (95% CI:0.68 to 0.87; P < 0.001]. CONCLUSION Findings suggest that prehabilitation is effective across all SES; however, participation across SES quintiles was not equal. Barriers to participation must be identified and addressed. Once these barriers are addressed, prehabilitation may reduce surgical disparities among SES.
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Affiliation(s)
- Dillon Lee
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Ao Wang
- Medical School for International Health, Ben-Gurion University of the Negev Be'er Sheva, 8410501, Israel
| | - Berson Augustin
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Emmalin Buajitti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | | | - Francesco Carli
- Department of Anesthesia, McGill University, Montréal, QC, Canada
| | - Chelsia Gillis
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada; Department of Anesthesia, McGill University, Montréal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada.
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Bausys A, Kryzauskas M, Abeciunas V, Degutyte AE, Bausys R, Strupas K, Poskus T. Prehabilitation in Modern Colorectal Cancer Surgery: A Comprehensive Review. Cancers (Basel) 2022; 14:5017. [PMID: 36291801 PMCID: PMC9599648 DOI: 10.3390/cancers14205017] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Colorectal cancer remains the third most prevalent cancer worldwide, exceeding 1.9 million new cases annually. Surgery continues to be the gold standard treatment option. Unfortunately, colorectal cancer surgery carries significant postoperative morbidity and mortality. Moreover, most rectal cancer patients and some patients with locally advanced colon cancer require preoperative neoadjuvant therapy. It improves long-term outcomes but impairs patients' physical fitness and thus further increases surgical risk. Recently, prehabilitation has gained interest as a novel strategy to reduce treatment-related morbidity for patients undergoing colorectal cancer surgery. However, the concept is still in its infancy, and the role of prehabilitation remains controversial. In this comprehensive review, we sum up present evidence on prehabilitation before colorectal cancer surgery. Available studies are very heterogenous in interventions and investigated outcomes. Nonetheless, all trials show at least some positive effects of prehabilitation on patients' physical, nutritional, or psychological status or even reduced postoperative morbidity. Unfortunately, the optimal prehabilitation program remains undetermined; therefore, this concept cannot be widely implemented. Future studies investigating optimal prehabilitation regimens for patients undergoing surgery for colorectal cancer are necessary.
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Affiliation(s)
- Augustinas Bausys
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Department of Abdominal Surgery and Oncology, National Cancer Institute, 08660 Vilnius, Lithuania
- Center for Visceral Medicine and Translational Research, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Vilius Abeciunas
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | | | - Rimantas Bausys
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Department of Abdominal Surgery and Oncology, National Cancer Institute, 08660 Vilnius, Lithuania
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
- Center for Visceral Medicine and Translational Research, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
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Thampy A, Palani Kumar MK, Serva Peddha M, Reddy M. The effectiveness of whey proteins in prevention and treatment of cancer: a review. Crit Rev Food Sci Nutr 2022; 64:2088-2104. [PMID: 36111369 DOI: 10.1080/10408398.2022.2121256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Cancer prevalence is rising rapidly around the globe, contributing immensely to the burden on health systems, hence the search for more effective and selective treatments still remains enticing. Whey, as a natural source, has received extensive focus in recent years because of its intriguing applications to health benefits. Growing consumer appreciation of the nutraceutical effects of whey components makes them an attractive field within cancer research. Whey is a valuable source of superior-quality proteins, lactose, vitamins, and minerals that contribute to proper nutrition as well as help hamper illness and even complement certain disease-related therapy prognosis. As a result, industry leaders and dairy producers are devising new ways to valorize it. Great emphasis on cancer prevention and treatment has been given to whey protein (WP) by the scientific community. WP intake has been proven to induce anti-cancer effects in various in vitro and in vivo studies. Nutritionists and dietitians are now enormously endorsing the role of WP in the therapeutic field, notably for cancer cachexia management. However, human intervention studies with WP are in their infancy and remain to be established with different tumor entities to provide valid proof of its ability to act as a coadjuvant in cancer treatment.
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Affiliation(s)
- Anjana Thampy
- Department of Clinical Nutrition and Dietetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
| | - Meena Kumari Palani Kumar
- Department of Biochemistry, CSIR-Central Food Technological Research Institute, Mysore, Karnataka, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Muthukumar Serva Peddha
- Department of Biochemistry, CSIR-Central Food Technological Research Institute, Mysore, Karnataka, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Madhavi Reddy
- Department of Clinical Nutrition and Dietetics, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India
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Aro R, Ohtonen P, Rautio T, Saarnio J, Mäkäräinen E, Häivälä R, Mäkinen MJ, Tuomisto A, Schwab U, Meriläinen S. Perioperative oral nutritional support for patients diagnosed with primary colon adenocarcinoma undergoing radical surgical procedures -Peri-Nutri Trial: study protocol for a randomized controlled trial. BMC Nutr 2022; 8:89. [PMID: 36050804 PMCID: PMC9438122 DOI: 10.1186/s40795-022-00591-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Colon cancer is one of the most common cancers in Finland and worldwide. Cancer-related malnutrition is a well-known risk factor for increased morbidity and mortality after surgery, and it is associated with complications and longer hospitalizations. There are no established recommendations on how to improve the nutritional status of colon cancer patients´ during the perioperative phase. Administration of simple oral nutritional supplements has been suggested to reduce complication rates, but evidence to support this practice is scarce. Methods The Peri-Nutri trial is a prospective, multicenter, randomized, controlled trial. Its primary endpoint is to evaluate whether perioperative oral nutritional support (ONS) decreases the number of complications during the 30-day follow-up after surgery. Secondary endpoints are to study the effect of ONS on quality of life after surgery, length of stay in institutional care, 90-day mortality rate, five-year disease-free survival and overall survival. The patients with a Nutritional risk screening 2002 (NRS-2002) questionnaire result between 2 and 5 (≥ 3 are classified at risk of malnutrition) will be randomized (1:1 ratio) into either the intervention or control group. The intervention group will receive preoperative ONS two weeks before the operation, and nutritional support will continue 10 days after the operation. The control group will not receive ONS. A total of 318 patients will be randomized into two groups and patients are followed five years. Discussion Peri-Nutri study evaluate the impact of ONS to short-term and long-term postoperative morbidity and mortality rates of colon cancer patients undergoing curative surgery. If ONS will decrease patients´ morbidity and mortality, that has a huge impact on patients´ quality of life and also to financial cost. Trial registration ClinicalTrials.gov, NCT03863236, Registered 25 February 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s40795-022-00591-y.
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Affiliation(s)
- Raila Aro
- Department of Gastrointestinal Surgery, Medical Research Center Oulu, Oulu University Hospital, PL 10, 90029 OYS, Oulu, Finland.
| | - Pasi Ohtonen
- Division of Operative Care, Medical Research Center Oulu, Oulu University Hospital, PL 10, 90029 OYS, Oulu, Finland
| | - Tero Rautio
- Department of Gastrointestinal Surgery, Medical Research Center Oulu, Oulu University Hospital, PL 10, 90029 OYS, Oulu, Finland
| | - Juha Saarnio
- Department of Gastrointestinal Surgery, Medical Research Center Oulu, Oulu University Hospital, PL 10, 90029 OYS, Oulu, Finland
| | - Elisa Mäkäräinen
- Department of Gastrointestinal Surgery, Medical Research Center Oulu, Oulu University Hospital, PL 10, 90029 OYS, Oulu, Finland
| | - Reetta Häivälä
- Department of Gastrointestinal Surgery, Medical Research Center Oulu, Oulu University Hospital, PL 10, 90029 OYS, Oulu, Finland
| | - Markus J Mäkinen
- Department of Pathology, Cancer and Translational Medicine Research Unit, University of Oulu, Oulu University Hospital and Medical Research Center Oulu, Oulu, Finland
| | - Anne Tuomisto
- Department of Pathology, University of Oulu, Oulu University Hospital and Medical Research Center Oulu, Oulu, Finland
| | - Ursula Schwab
- School of Medicine, Institute of Public Health and Clinical Nutrition, Finland and Department of Medicine, Endocrinology and Clinical Nutrition, University of Eastern, Kuopio University Hospital, Kuopio, Finland
| | - Sanna Meriläinen
- Department of Gastrointestinal Surgery, Medical Research Center Oulu, Oulu University Hospital, PL 10, 90029 OYS, Oulu, Finland.
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Corriveau J, Alavifard D, Gillis C. Demystifying Malnutrition to Improve Nutrition Screening and Assessment in Oncology. Semin Oncol Nurs 2022; 38:151336. [PMID: 35995630 DOI: 10.1016/j.soncn.2022.151336] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Patients with cancer and malnutrition are more likely to experience poor treatment tolerance, prolonged length of hospital stay, and decreased quality of life. Early and sustained nutrition risk screening is the first step to tackling this patient and health care burden. Yet, malnutrition remains largely overlooked and undertreated. Malnutrition mismanagement could be indicative of a systemic misunderstanding. With this narrative review, we aimed to (1) define malnutrition, (2) address common malnutrition misconceptions, and (3) summarize nutrition recommendations for patients with cancer. DATA SOURCES PubMed and international clinical practice guidelines were used. CONCLUSION Malnutrition represents an unbalanced nutritional state that alters body composition and diminishes function. Malnutrition is not always physically obvious, and albumin is not a reliable marker of nutritional status; therefore, systematically screening all patients with a validated nutrition risk screening tool at time of cancer diagnosis, and periodically throughout treatment, is necessary to provide optimal, equitable care. Nutrition risk screening takes less than 1 minute to complete and can be completed by any health care professional. Patients that screen positive for nutrition risk should be referred to a registered nutritionist or dietitian for comprehensive nutritional assessment, diagnosis, and treatment. IMPLICATIONS FOR NURSING PRACTICE All health care professionals can and should be responsible for preventing and treating malnutrition. Registered nurses can actively participate in improving patient outcomes by screening patients for nutrition risk, weighing patients at every visit, referring patients to dietitians for nutrition treatment, and providing supportive medical management of nutrition impact symptoms such as nausea.
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Affiliation(s)
- Jade Corriveau
- Department of Nutrition, McGill University Health Centre, Montreal, QC, Canada
| | - Dorsa Alavifard
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Chelsia Gillis
- Department of Anesthesia, McGill University, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; School of Human Nutrition, McGill University, McGill University, Montreal, QC, Canada.
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Nutritional prehabilitation in head and neck cancer: a systematic review. Support Care Cancer 2022; 30:8831-8843. [PMID: 35913625 DOI: 10.1007/s00520-022-07239-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Prehabilitation affords an opportunity to support the management of malnutrition that is strongly associated with head and neck cancer. The purpose of this systematic review was to identify the components of nutritional prehabilitation interventions and their effects on nutritional and health outcomes in head and neck cancer patients. METHODS A comprehensive search was completed within Medline (including PubMed), CINHAL, Cochrane database, EMBASE, PRoQUEST, clinical trials registries, and grey literature to identify studies involving a nutritional intervention pre-treatment in head and neck cancer patients receiving any form of curative therapy. Nutritional intervention was defined as a specified period pre-treatment and outcome measures had to include assessment of nutritional status or body composition. Quality of included studies was assessed using Cochrane risk of bias 2. RESULTS From 557 identified studies, two met the inclusion criteria. Due to the low number of studies, a meta-analysis was not indicated. Both studies conducted a nutritional intervention using an "enriched formula" in malnourished patients prior to surgery. Neither study reported the intervention was effective for reducing weight loss, physical function, surgical complications, or length of stay versus the comparison. CONCLUSION There is limited nutritional prehabilitation research within head and neck cancer. An "enriched formula" provided in the prehabilitation period appears no more advantageous than routine standard nutritional formula in mitigating against the weight loss experienced in malnourished head and neck patient. Due to the malnutrition risks on diagnosis and the negative impact of poor nutritional status on clinical and functional outcomes, robust nutritional prehabilitation research is required to inform clinical practice.
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Zhang X, Wang S, Ji W, Wang H, Zhou K, Jin Z, Bo L. The effect of prehabilitation on the postoperative outcomes of patients undergoing colorectal surgery: A systematic review and meta-analysis. Front Oncol 2022; 12:958261. [PMID: 35965591 PMCID: PMC9372464 DOI: 10.3389/fonc.2022.958261] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/05/2022] [Indexed: 11/30/2022] Open
Abstract
Study objective Prehabilitation is analogous to marathon training and includes preoperative preparation for exercise, as well as nutrition and psychology. However, evidence-based recommendations to guide prehabilitation before colorectal surgery are limited. We aimed to evaluate the effect of prehabilitation on the postoperative outcomes of patients undergoing colorectal surgery. Design This study is a systematic review and meta-analysis. Methods The PubMed, Embase, and Cochrane databases were searched for studies reporting the effect of prehabilitation strategies versus standard care or rehabilitation in patients undergoing colorectal surgery. The primary outcomes were overall postoperative complications and length of hospital stay (LOS), and the secondary outcome was functional capacity (measured using the 6-min walk test [6MWT]) at 4 and 8 weeks after surgery. Main results Fifteen studies with 1,306 participants were included in this meta-analysis. The results showed no significant reduction in the number of overall postoperative complications (risk ratio = 1.02; 95% confidence interval [CI] = 0.79-1.31; p = 0.878) or LOS (standardized mean difference = 0.04; 95% CI = -0.11 to 0.20; p = 0.589) in patients who underwent colorectal surgery with or without prehabilitation strategy. Additionally, there were no significant differences in the functional capacity estimated using the 6MWT at 4 and 8 weeks postoperatively. Conclusions Prehabilitation did not significantly affect the number of postoperative complications, LOS, or functional capacity of patients undergoing colorectal surgery. Whether prehabilitation should be recommended deserves further consideration. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=290108, identifier CRD42021290108.
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Affiliation(s)
- Xiaoting Zhang
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shaokang Wang
- Department of Emergency, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Wentao Ji
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Huixian Wang
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Keqian Zhou
- College of Basic Medicine, Naval Medical University, Shanghai, China
| | - Zhichao Jin
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Lulong Bo
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
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Postoperative Diet with an Oligomeric Hyperproteic Normocaloric Supplement versus a Supplement with Immunonutrients in Colorectal Cancer Surgery: Results of a Multicenter, Double-Blind, Randomized Clinical Trial. Nutrients 2022; 14:nu14153062. [PMID: 35893914 PMCID: PMC9331223 DOI: 10.3390/nu14153062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Background: For normo-nourished colorectal cancer patients, the need for immunonutrients after elective surgery is not known. (2) Methods: Multicenter, randomized, double-blind, phase III clinical trial comparing the postoperative diet with 200 mL oligomeric hyperproteic normocaloric (OHN; experimental arm) supplement vs. 200 mL immunonutritional (IN) (active comparator) supplement twice a day for five days in 151 normo-nourished adult colorectal-resection patients following the multimodal rehabilitation ERAS protocol. The proportions of patients with complications (primary outcome) and those who were readmitted, hospitalized for <7 days, had surgical site infections, or died due to surgical complications (secondary outcome) were compared between the two groups until postoperative day 30. Tolerance to both types of supplement and blood parameters was also assessed until day 5. (3) Results: Mean age was 69.2 and 84 (58.7%) were men. Complications were reported in 41 (28.7%) patients and the incidence did not differ between groups (18 (25%) vs. 23 (32.4%) patients with OHN and IN supplement, respectively; p = 0.328). No significant differences were found for the rest of the variables. (4) Conclusions: IN supplement may not be necessary for the postoperative recovery of colorectal cancer patients under the ERAS regimen and with normal nutritional status at the time of surgery.
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Kerr A, Lugg ST, Kadiri S, Swift A, Efstathiou N, Kholia K, Rogers V, Fallouh H, Steyn R, Bishay E, Kalkat M, Naidu B. Feasibility study of a randomised controlled trial of preoperative and postoperative nutritional supplementation in major lung surgery. BMJ Open 2022; 12:e057498. [PMID: 35768119 PMCID: PMC9240939 DOI: 10.1136/bmjopen-2021-057498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Malnutrition and weight loss are important risk factors for complications after lung surgery. However, it is uncertain whether modifying or optimising perioperative nutritional state with oral supplements results in a reduction in malnutrition, complications or quality of life. DESIGN A randomised, open label, controlled feasibility study was conducted to assess the feasibility of carrying out a large multicentre randomised trial of nutritional intervention. The intervention involved preoperative carbohydrate-loading drinks (4×200 mL evening before surgery and 2×200 mL the morning of surgery) and early postoperative nutritional protein supplement drinks two times per day for 14 days compared with the control group receiving an equivalent volume of water. SETTING Single adult thoracic centre in the UK. PARTICIPANTS All adult patients admitted for major lung surgery. Patients were included if were able to take nutritional drinks prior to surgery and give written informed consent. Patients were excluded if they were likely unable to complete the study questionnaires, they had a body mass index <18.5 kg/m2, were receiving parenteral nutrition or known pregnancy. RESULTS All patients presenting for major lung surgery were screened over a 6-month period, with 163 patients screened, 99 excluded and 64 (41%) patients randomised. Feasibility criteria were met and the study completed recruitment 5 months ahead of target. The two groups were well balanced and tools used to measure outcomes were robust. Compliance with nutritional drinks was 97% preoperatively and 89% postoperatively; 89% of the questionnaires at 3 months were returned fully completed. The qualitative interviews demonstrated that the trial and the intervention were acceptable to patients. Patients felt the questionnaires captured their experience of recovery from surgery well. CONCLUSION A large multicentre randomised controlled trial of nutritional intervention in major lung surgery is feasible and required to test clinical efficacy in improving outcomes after surgery. TRIAL REGISTRATION NUMBER ISRCTN16535341.
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Affiliation(s)
- Amy Kerr
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sebastian T Lugg
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Salma Kadiri
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amelia Swift
- Institute of Clinical Sciences and School of Nursing, University of Birmingham, Birmingham, UK
| | - Nikolaos Efstathiou
- Institute of Clinical Sciences and School of Nursing, University of Birmingham, Birmingham, UK
| | - Krishna Kholia
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Venessa Rogers
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hazem Fallouh
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Steyn
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ehab Bishay
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Maninder Kalkat
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Babu Naidu
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Gillis C, Martinez MC, Mina DS. Tailoring prehabilitation to address the multifactorial nature of functional capacity for surgery. J Hum Nutr Diet 2022; 36:395-405. [PMID: 35716131 DOI: 10.1111/jhn.13050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
Abstract
Mounting evidence suggests that recovery begins before the surgical incision. The pre-surgery phase of recovery - the preparation for optimal surgical recovery - can be reinforced with prehabilitation. Prehabilitation is the approach of enhancing the functional capacity of the individual to enable them to withstand a stressful event. With this narrative review, we apply the Wilson & Cleary conceptual model of patient outcomes to specify the complex and integrative relationship of health factors that limit functional capacity before surgery. To have the greatest impact on patient outcomes, prehabilitation programs require individualized and coordinated care from medical, nutritional, psychosocial, and exercise services. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Chelsia Gillis
- School of Human Nutrition, McGill University.,Anesthesia Department, McGill University
| | | | - Daniel Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto.,Department of Anesthesia and Pain Management, University Health Network
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Olvera-Rosales LB, Cruz-Guerrero AE, García-Garibay JM, Gómez-Ruíz LC, Contreras-López E, Guzmán-Rodríguez F, González-Olivares LG. Bioactive peptides of whey: obtaining, activity, mechanism of action, and further applications. Crit Rev Food Sci Nutr 2022; 63:10351-10381. [PMID: 35612490 DOI: 10.1080/10408398.2022.2079113] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Bioactive peptides derived from diverse food proteins have been part of diverse investigations. Whey is a rich source of proteins and components related to biological activity. It is known that proteins have effects that promote health benefits. Peptides derived from whey proteins are currently widely studied. These bioactive peptides are amino acid sequences that are encrypted within the first structure of proteins, which required hydrolysis for their release. The hydrolysis could be through in vitro or in vivo enzymatic digestion and using microorganisms in fermented systems. The biological activities associated with bio-peptides include immunomodulatory properties, antibacterial, antihypertensive, antioxidant and opioid, etc. These functions are related to general conditions of health or reduced risk of certain chronic illnesses. To determine the suitability of these peptides/ingredients for applications in food technology, clinical studies are required to evaluate their bioavailability, health claims, and safety of them. This review aimed to describe the biological importance of whey proteins according to the incidence in human health, their role as bioactive peptides source, describing methods, and obtaining technics. In addition, the paper exposes biochemical mechanisms during the activity exerted by biopeptides of whey, and their application trends.
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Affiliation(s)
- L B Olvera-Rosales
- Universidad Autónoma del Estado de Hidalgo, Área Académica de Química, Ciudad del Conocimiento, Mineral de la Reforma, Hidalgo, México
| | - A E Cruz-Guerrero
- Departamento de Biotecnología, Universidad Autónoma Metropolitana, Unidad Iztapalapa. División de Ciencias Biológicas y de la Salud, Colonia Vicentina, Ciudad de México, México
| | - J M García-Garibay
- Departamento de Biotecnología, Universidad Autónoma Metropolitana, Unidad Iztapalapa. División de Ciencias Biológicas y de la Salud, Colonia Vicentina, Ciudad de México, México
- Departamento de Ciencias de la Alimentación Lerma de Villada, Universidad Autónoma Metropolitana-Lerma, Edo. de México, México
| | - L C Gómez-Ruíz
- Departamento de Biotecnología, Universidad Autónoma Metropolitana, Unidad Iztapalapa. División de Ciencias Biológicas y de la Salud, Colonia Vicentina, Ciudad de México, México
| | - E Contreras-López
- Universidad Autónoma del Estado de Hidalgo, Área Académica de Química, Ciudad del Conocimiento, Mineral de la Reforma, Hidalgo, México
| | - F Guzmán-Rodríguez
- Departamento de Biotecnología, Universidad Autónoma Metropolitana, Unidad Iztapalapa. División de Ciencias Biológicas y de la Salud, Colonia Vicentina, Ciudad de México, México
| | - L G González-Olivares
- Universidad Autónoma del Estado de Hidalgo, Área Académica de Química, Ciudad del Conocimiento, Mineral de la Reforma, Hidalgo, México
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Wooten SV, Wolf JS, Mendoza D, Bartholomew JB, Stanforth PR, Stanforth D, Tanaka H, Fleming RYD. The Impact of a Multimodal Sport Science-Based Prehabilitation Program on Clinical Outcomes in Abdominal Cancer Patients: A Cohort Study. Am Surg 2022; 88:2302-2308. [PMID: 35608376 DOI: 10.1177/00031348221103657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The potential for prehabilitation programs to impact clinical outcomes is uncertain in abdominal cancer patients due to the short window of time to intervene and the weakened state of the patients. To improve the effectiveness of prehabilitation intervention, a multimodal sports science approach was implemented. METHODS Prior to cancer-related surgery, 21 patients participated in a 4-week exercise and nutrition prehabilitation program comprised of blood flow restriction exercise (BFR) and a sports nutrition supplement. Retrospective data of 71 abdominal cancer patients who underwent usual preoperative care was used as a comparator control group (CON). At 90 days post-surgery, clinical outcomes were quantified. RESULTS Prehabilitation was associated with a shorter length of hospital stay (P = .02) with 5.5 fewer days (4.7 ± 2.1 vs 10.2 ± 1.2 days in CON) and decreased incidence of any complications (P = .03). Prehabilitation was not related to incidence of serious complications (P = .17) or readmission rate (P = .59). The prehabilitation group recorded 58% more steps on day 5 after surgery (P = .043). DISCUSSION A 4-week home-based prehabilitation program composed of BFR training and sports nutrition supplementation was effective in reducing postoperative complications and length of hospital stay in older patients with abdominal cancer.ClinicalTrials.gov Identifier: NCT04073381.
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Affiliation(s)
- Savannah V Wooten
- Department of Kinesiology and Health Education, 4002The University of Texas at Austin, Austin, TX, USA
| | - J Stuart Wolf
- Department of Surgery and Periopertative Care, 12330The University of Texas at Austin, Austin, TX, USA
| | - Diana Mendoza
- Department of Surgery and Periopertative Care, 12330The University of Texas at Austin, Austin, TX, USA
| | - John B Bartholomew
- Department of Kinesiology and Health Education, 4002The University of Texas at Austin, Austin, TX, USA
| | - Philip R Stanforth
- Department of Kinesiology and Health Education, 4002The University of Texas at Austin, Austin, TX, USA
| | - Dixie Stanforth
- Department of Kinesiology and Health Education, 4002The University of Texas at Austin, Austin, TX, USA
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, 4002The University of Texas at Austin, Austin, TX, USA
| | - R Y Declan Fleming
- Department of Surgery and Periopertative Care, 12330The University of Texas at Austin, Austin, TX, USA
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Molenaar CJ, van Rooijen SJ, Fokkenrood HJ, Roumen RM, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database Syst Rev 2022; 5:CD013259. [PMID: 35588252 PMCID: PMC9118366 DOI: 10.1002/14651858.cd013259.pub2] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Surgery is the cornerstone in curative treatment of colorectal cancer. Unfortunately, surgery itself can adversely affect patient health. 'Enhanced Recovery After Surgery' programmes, which include multimodal interventions, have improved patient outcomes substantially. However, these are mainly applied peri- and postoperatively. Multimodal prehabilitation includes multiple preoperative interventions to prepare patients for surgery with the aim of increasing resilience, thereby improving postoperative outcomes. OBJECTIVES To determine the effects of multimodal prehabilitation programmes on functional capacity, postoperative complications, and quality of life in adult patients undergoing surgery for colorectal cancer. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and PsycINFO in January 2021. We also searched trial registries up to March 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) in adult patients with non-metastatic colorectal cancer, scheduled for surgery, comparing multimodal prehabilitation programmes (defined as comprising at least two preoperative interventions) with no prehabilitation. We focused on the following outcomes: functional capacity (i.e. 6-minute walk test, VO2peak, handgrip strength), postoperative outcomes (i.e. complications, mortality, length of hospital stay, emergency department visits, re-admissions), health-related quality of life, compliance, safety of prehabilitation, and return to normal activities. DATA COLLECTION AND ANALYSIS Two authors independently selected studies, extracted data, assessed risk of bias and used GRADE to assess the certainty of the evidence. Any disagreements were solved with discussion and consensus. We pooled data to perform meta-analyses, where possible. MAIN RESULTS We included three RCTs that enrolled 250 participants with non-metastatic colorectal cancer, scheduled for elective (mainly laparoscopic) surgery. Included trials were conducted in tertiary care centres and recruited patients during periods ranging from 17 months to 45 months. A total of 130 participants enrolled in a preoperative four-week trimodal prehabilitation programme consisting of exercise, nutritional intervention, and anxiety reduction techniques. Outcomes of these participants were compared to those of 120 participants who started an identical but postoperative programme. Postoperatively, prehabilitation may improve functional capacity, determined with the 6-minute walk test at four and eight weeks (mean difference (MD) 26.02, 95% confidence interval (CI) -13.81 to 65.85; 2 studies; n = 131; and MD 26.58, 95% CI -8.88 to 62.04; 2 studies; n = 140); however, the certainty of evidence is low and very low, respectively, due to serious risk of bias, imprecision, and inconsistency. After prehabilitation, the functional capacity before surgery improved, with a clinically relevant mean difference of 24.91 metres (95% CI 11.24 to 38.57; 3 studies; n = 225). The certainty of evidence was moderate due to downgrading for serious risk of bias. Prehabilitation may also result in fewer complications (RR 0.95, 95% CI 0.70 to 1.29; 3 studies; n = 250) and fewer emergency department visits (RR 0.72, 95% CI 0.39 to 1.32; 3 studies; n = 250). The certainty of evidence was low due to downgrading for serious risk of bias and imprecision. On the other hand, prehabilitation may also result in a higher re-admission rate (RR 1.20, 95% CI 0.54 to 2.65; 3 studies; n = 250). The certainty of evidence was again low due to downgrading for risk of bias and imprecision. The effect on VO2peak, handgrip strength, length of hospital stay, mortality rate, health-related quality of life, return to normal activities, safety of the programme, and compliance rate could not be analysed quantitatively due to missing or insufficient data. The included studies did not report a difference between groups for health-related quality of life and length of hospital stay. Data on remaining outcomes were not reported or were reported inadequately in the included studies. AUTHORS' CONCLUSIONS Prehabilitation may result in an improved functional capacity, determined with the 6-minute walk test both preoperatively and postoperatively. Complication rates and the number of emergency department visits postoperatively may also diminish due to a prehabilitation programme, while the number of re-admissions may be higher in the prehabilitation group. The certainty of evidence ranges from moderate to very low, due to downgrading for serious risk of bias, imprecision and inconsistency. In addition, only three heterogeneous studies were included in this review. Therefore, the findings of this review should be interpreted with caution. Numerous relevant RCTs are ongoing and will be included in a future update of this review.
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Affiliation(s)
| | | | | | - Rudi Mh Roumen
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
| | - Loes Janssen
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
| | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Centre, Veldhoven, Netherlands
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50
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Connolly-Schoonen J, Biamonte SF, Danowski L, Montrose DC. Modifying dietary amino acids in cancer patients. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2022; 373:1-36. [PMID: 36283763 DOI: 10.1016/bs.ircmb.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Limiting nutrient utilization by cancer cells in order to disrupt their metabolism and suppress their growth represents a promising approach for anti-cancer therapy. Recently, studies demonstrating the anti-neoplastic effects of lowering amino acid (AA) availability have opened up an exciting and quickly growing field of study. Although intracellular synthesis can often provide the AAs necessary to support cancer cells, diet and the tumor microenvironment can also be important sources. In fact, studies carried out in vitro and in animal tumor models have supported the anti-cancer potential of restricting exogenous sources of AAs. However the potential benefit of reducing AA intake in cancer patients requires further investigation. Furthermore, implementation of such an approach clinically, even if proven useful, could be challenging. In the enclosed review, we (1) summarize the pre-clinical studies showing the anti-tumorigenic effects of restricting exogenously available AAs, including through reducing dietary protein, (2) consider the role of microbiota in this process, (3) report on current recommendations for protein intake in cancer patients and studies that applied these guidelines, and (4) propose considerations for studies to test the potential therapeutic benefit of reducing protein/AA consumption in patients with cancer.
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Affiliation(s)
- Josephine Connolly-Schoonen
- Department of Family, Population & Preventive Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Steven F Biamonte
- Department of Family, Population & Preventive Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Lorraine Danowski
- Department of Family, Population & Preventive Medicine, Stony Brook University, Stony Brook, NY, United States
| | - David C Montrose
- Department of Pathology, Stony Brook University, Stony Brook, NY, United States; Stony Brook Cancer Center, Stony Brook, NY, United States.
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