The impact of prehabilitation on patient outcomes in hepatobiliary, colorectal, and upper gastrointestinal cancer surgery : a PRISMA-accordant meta-analysis

Lambert, Joel and Hayes, Lawrence and Keegan, Thomas and Subar, Daren and Gaffney, Christopher (2020) The impact of prehabilitation on patient outcomes in hepatobiliary, colorectal, and upper gastrointestinal cancer surgery : a PRISMA-accordant meta-analysis. Annals of Surgery. 0-0. ISSN 0003-4932

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Abstract

Objective: To determine the impact of prehabilitation on hospital length of stay, functional capacity, complications, and mortality after surgery in patients with hepatobiliary, colorectal, and upper gastrointestinal cancer. Background: “Prehabilitation” encompasses exercise, nutrition, and psychosocial interventions to optimise health before surgery. The benefits of prehabilitation are ill-defined. Methods: Medline, Embase and Cochrane Databases were searched systematically for the terms “prehabilitation AND exercise”, “perioperative care AND cancer surgery”, and “colorectal AND hepatobiliary AND hepatopancreatobiliary AND oesophagogastric AND recovery AND outcomes”. Primary outcomes analysed were hospital length of stay, functional capacity, significant post-operative complications (Clavien Dindo  III), and mortality. A meta-analysis was conducted on the effect of all-modality prehabilitation for patients with colorectal, hepatopancreatobiliary and upper gastrointestinal cancer surgery using the raw mean difference, risk difference, and a random-effects model. Results: 337 original titles were identified. 15 studies (randomised controlled trials; n = 9 and uncontrolled trials; n = 6) were included in the meta-analysis. Prehabilitation reduced hospital length of stay by 1.78 days versus standard care (95% CI: -3.36, -0.20, P <0.05). There was no significant difference in functional capacity with prehabilitation determined using the six-minute walk test (P = 0.816) and no significant reduction in post-operative complications (P = 0.378) or mortality rates (P = 0.114). Conclusion: Prehabilitation was associated with reduced hospital length of stay but had no effect on functional capacity, post-operative complications, or mortality rates. Thus, prehabilitation should be recommended to accelerate recovery from cancer surgery, demonstrated by reduced hospital length of stay.