护研苑 | 肿瘤衰弱干预专题

Effects of prehabilitation on postoperative outcomes in frail cancer patients undergoing elective surgery: a systematic review and meta-analysis

Purpose: This systematic review and meta-analysis aimed to explore the effects of prehabilitation on postoperative outcomes in frail cancer patients.

Methods: A comprehensive literature search was conducted using Pubmed, Cochrane Library, Embase, Web of Science, CINAHL Complete, and other databases from database inception to 15th March of 2022. Studies were included if they consisted of a prehabilitation intervention in frail cancer patients undergoing elective surgery.

Results: A total of 9 studies encompassing 1,313 patients were included in the review. Through meta-analysis, prehabilitation has a positive impact on total complications (RR=0.83, 95%CI=0.73 to 0.94, P=0.004), severe complications. (RR=0.62, 95%CI=0.43 to 0.90, P=0.01) and the average length of hospital stay (MD=-1.36, 95%CI=-2.38 to -0.35, P=0.008). But it had no differences in 30-day and 3-month mortality, 30-day and 3-month readmission rates. Through qualitative synthesis, two studies found that prehabilitation had a favorable tendency to promote functional recovery compared with the control group.

Conclusion: Prehabilitation had a positive effect on postoperative complications and the average length of hospital stay in frail cancer patients. A personalized and supervised multimodal prehabilitation program with exercise at its core may be more beneficial for them. More studies with extensive follow-up are needed to confirm and update the findings of these results.

全文链接：

Guo Y, Ding L, Miao X, Jiang X, Xu T, Xu X, Zhu S, Xu Q, Hu J. Effects of prehabilitation on postoperative outcomes in frail cancer patients undergoing elective surgery: a systematic review and meta-analysis. Support Care Cancer. 2022 Dec 19;31(1):57. doi: 10.1007/s00520-022-07541-1. PMID: 36534300.

补充参考文献：

[1] Isharwal S, Johanning JM, Dwyer JG, et al. (2017) Preoperative frailty predicts postoperative complications and mortality in urology patients World journal of urology 35: 21-26. DOI:10.1007/s00345-016-1845-z.

[2] Achilli P, Mazzola M, Bertoglio CL, et al. (2020) Preoperative immunonutrition in frail patients with colorectal cancer: an intervention to improve postoperative outcomes International journal of colorectal disease 35: 19-27. DOI: 10.1007/s00384-019-03438-4.

该研究通过Meta分析，全面系统地分析了目前国内外有关预康复研究对衰弱癌症患者术后健康结局的影响。选题具有创新性，紧密结合临床，统计分析方法恰当，且具有临床意义。最后结论归纳得出了一套具有可实施的预康复衰弱干预方案及建议，可为今后针对肿瘤衰弱人群开展衰弱管理、临床干预类研究提供了循证依据。