Can we “prehabilitate” pancreatic cancer patients prior to surgery? A critical appraisal of the literature

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dc.contributor.authorRefaat, M.
dc.contributor.authorModak, S.
dc.contributor.authorHarivelam, C.
dc.contributor.authorUllah, S.
dc.contributor.authorFerrar, K.
dc.contributor.authorPandya, S.
dc.contributor.authorRebala, P.
dc.contributor.authorRao, G.V.
dc.contributor.authorde Boer, H.D.
dc.contributor.authorBarreto, S.G.
dc.contributor.authorKarunakaran, M.
dc.date.issued2024
dc.description.abstractBackground: Enhancing a patient's functional capacity to withstand the surgical stress by means of multimodal (combined exercise, nutrition and psychological interventions) prehabilitation may potentially lead to improved outcomes in pancreatic cancer surgery. Methodology: A systematic review was undertaken searching PubMed, Google Scholar and Cochrane Library databases, exploring the impact of prehabilitation in pancreatic surgery. Outcomes of interest were adherence to the prehabilitation, functional capacity, overall complications and post-operative length of stay. Pooled analysis was performed using a random-effects model. Results: Twelve studies comprising of 1497 patients were included in the review. Most of the studies seem to lack a multimodal approach. Less than 50 % of the studies reported adherence, which ranged between 27 and 100 %. Functional capacity, in terms of 6-min walk test, showed improvement with prehabilitation. Among the post-operative outcomes, prehabilitation was associated with significant improvement in pulmonary complications (2.4 % versus 6.7 %, RR 0.36, CI 0.17e0.74, p ¼ 0.01, I(2) ¼ 28%). Prehabilitation was not effective in terms of length of stay or readmission rates. Conclusions: Larger studies with multimodal prehabilitation approaches may demonstrate more consistent and clinically meaningful benefits, which would lead to a firm appreciation of its role the management of pancreatic cancer patients undergoing surgery.
dc.description.statementofresponsibilityMina Refaat, Shreeyash Modak, Chidananda Harivelam, Shahid Ullah, Katia Ferrar, Sunil Pandya, Pradeep Rebala, G.V. Rao, Hans D. de Boer, Savio George Barreto, Monish Karunakaran
dc.identifier.citationClinical Nutrition ESPEN, 2024; 63:845-855
dc.identifier.doi10.1016/j.clnesp.2024.08.003
dc.identifier.issn2405-4577
dc.identifier.issn2405-4577
dc.identifier.orcidUllah, S. [0000-0002-1825-7774] [0000-0003-0010-2640]
dc.identifier.urihttps://hdl.handle.net/2440/143867
dc.language.isoen
dc.publisherElsevier BV
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/2021009
dc.rights© 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
dc.source.urihttp://dx.doi.org/10.1016/j.clnesp.2024.08.003
dc.subjectExercise
dc.subjectNutrition
dc.subjectOutcomes
dc.subjectPancreaticoduodenectomy
dc.subjectQuality
dc.subject.meshHumans
dc.subject.meshPancreatic Neoplasms
dc.subject.meshPostoperative Complications
dc.subject.meshTreatment Outcome
dc.subject.meshLength of Stay
dc.subject.meshPreoperative Care
dc.subject.meshPancreatectomy
dc.subject.meshPreoperative Exercise
dc.titleCan we “prehabilitate” pancreatic cancer patients prior to surgery? A critical appraisal of the literature
dc.typeJournal article
pubs.publication-statusPublished

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