Prehabilitation prior to surgery for pancreatic cancer: A systematic review |
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| Affiliation: | 1. College of Medical and Dental Sciences, University of Leeds, UK;2. Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle, UK;3. Institute of Cellular Medicine, Newcastle University, Newcastle, UK;4. Department of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle, UK;5. Population Health Sciences Institute, Newcastle University, Newcastle, UK;1. Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore;2. Department of Physiotherapy, Tan Tock Seng Hospital, Singapore, Singapore;1. Department of Kinesiology and Physical Education, McGill University, Montreal, Quebec, Canada;2. Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada;3. Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada;1. Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, 1200 Brussels, Belgium;2. Service de Médecine Physique et Réadaptation, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;3. Institut de Recherche Expérimentale et Clinique (IREC), Neuro Musculo Skeletal Lab (NMSK), Université Catholique de Louvain, 1200 Brussels, Belgium;4. Service de Pneumologie, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;1. Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada;2. Canadian Agency for Drugs and Technologies in Health, Ottawa, Ontario, Canada;3. O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada;4. Department of Anesthesia, McGill University Health Center, Montreal, Quebec, Canada;5. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada;6. Faculty of Kinesiology and Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;7. Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada;8. Department of Community Health Sciences, Institute of Public Health, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada;9. Nutrition Services, Alberta Health Services, Calgary, Canada |
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| Abstract: | IntroductionPrehabilitation aims to improve fitness and outcomes of patients undergoing major surgery. This systematic review aimed to appraise current available evidence regarding the role of prehabilitation in patients undergoing oncological pancreatic resection.MethodsA systematic literature search of PUBMED, MEDLINE, EMBASE databases identified articles describing prehabilitation programmes before pancreatic resection for malignancy. Data collected included timing of prehabilitation, programme type, duration, adherence and post-operative outcome reporting.ResultsSix studies, including 193 patients were included in the final analysis. Three studies included patients undergoing neoadjuvant therapy followed by resection and 3 studies included patients undergoing upfront resection. Time from diagnosis to surgery ranged between 2 and 22 weeks across all studies. Two studies reported a professionally supervised exercise programme, and four described unsupervised programmes. Exercise programmes varied from 5 days to 6 months in duration. Adherence to exercise programmes was better with supervised programmes (99% reaching weekly activity goal vs 85%) and patients not undergoing neoadjuvant therapy (90% reaching weekly activity goal vs 82%). All studies reported improvement in muscle mass or markers of muscle function following prehabilitation. Two studies reported the impact of Prehabilitation on postoperative outcomes and Prehabilitation was associated with lower delayed gastric emptying and a shorter hospital stay with no impact on other postoperative outcomes.ConclusionEarly evidence demonstrates that Prehabilitation programmes may improve postoperative outcomes following pancreatic surgery. However current Prehabilitaton programmes for patients undergoing pancreatic resection report diverse exercise regimens with no consensus regarding timing or length of Prehabilitation, warranting a need for standardisation of Prehabilitation programmes in pancreatic surgery. |
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| Keywords: | Prehabilitation Pancreatic cancer Pancreatic resection Pancreaticoduodenectomy |
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