Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende Patientenratgeber
Erweiterte Suche
Anmelden
nach oben
International Journal of Colorectal Disease
Erschienen in:

10.01.2022 | Review

Prehabilitation in rectal surgery: a narrative review

verfasst von: E. Hannan, M. E. Kelly, M. R. Fahy, D. C. Winter

Erschienen in: International Journal of Colorectal Disease | Ausgabe 2/2022

Einloggen, um Zugang zu erhalten

Abstract

Aim

Neoadjuvant chemotherapy (NACRT) can make decompensated patients more vulnerable prior to rectal surgery. Prehabilitation is an intervention which enhances functional capacity to withstand the stress of surgery. The aim of this review was to evaluate the impact of prehabilitation for patients undergoing rectal surgery on physical fitness and clinical outcomes and to establish feasibility of prehabilitation.

Methods

An analysis of the literature was conducted of PubMed, the Cochrane Library, MEDLINE, EMBASE and ScienceDirect. Articles were initially included based on their title and abstracts reviewed. Full-text copies of those selected were obtained for confirmation of inclusion.

Results

Eight studies were included. Heterogenicity was observed in the structure of exercise programmes. Improvements in physical fitness were observed in six studies. One study demonstrated a statistically significant improvement in quality of life. The prehabilitation programmes were shown to be feasible, with high completion rates. No adverse events were reported. There was limited data regarding the impact of prehabilitation on postoperative outcomes.

Conclusion

Current evidence on prehabilitation in rectal surgery has considerable heterogenicity in both structure of programmes and outcome measures. Standardisation is required for future evaluation of the impact on outcomes. A trimodal approach of exercise, nutritional and psychological interventions has been employed in similar programmes, and should be used in rectal surgery. The intervention should be tailored to the patient and environment. This review highlights the benefits, safety and feasibility of prehabilitation and provides a platform for consensus-building for international trials.
Literatur
1.
Wasserberg N (2014) Interval to surgery after neoadjuvant treatment for colorectal cancer. World J Gastroenterol 20:4256–4262CrossRef
2.
3.
Mohiuddin M, Pauluas R, Mitchell E et al (2013) Neoadjuvant chemoradiation for distal rectal cancer: 5-year updated results of a randomized phase 2 study of neoadjuvant combined modality chemoradiation for distal rectal cancer. J Radiat Oncol Bio Phys 86:523–528CrossRef
4.
Gerard A, Buyse M, Nordinger B et al (1988) Preoperative radiotherapy as adjuvant treatment in rectal cancer. Final results of a randomised study of the European Organisation for Research and Treatment of Cancer (EORTC). Ann Surg 208: 606–14
5.
Loughney L, West MA, Kemp GJ et al (2016) The effects of neoadjuvant chemoradiotherapy and an in-hospital exercise training programme on physical fitness and quality of life in locally advanced rectal cancer patients (The EMPOWER Trial): study protocol for a randomised controlled trial. Trials 17:24CrossRef
6.
Swellengrebel HA, Marijnen CA, Verwaal VJ et al (2011) Toxicity and complications of preoperative chemoradiotherapy for locally advanced rectal cancer. Br J Surg 98(3):418–426CrossRef
7.
Swellengrebel HA, Marijnen CA, Verwall VJ et al (2011) Toxicity and complications of preoperative chemoradiotherapy for locally advanced rectal cancer. Br J Surg 98:418–426CrossRef
8.
9.
Brown SC, Abraham JS, Walsh S, Sykes PA (1991) Risk factors and operative mortality in surgery for colorectal cancer. Ann R Coll Surg Engl 73:269–272PubMedPubMedCentral
10.
Brunet J, Burke S, Grocott M et al (2017) The effects of exercise on pain, fatigue, insomnia and health perceptions in patients with operable advanced stage rectal cancer prior to surgery: a pilot trial. BMC Cancer 17(1):153CrossRef
11.
Simunovic M, Gagliardi A, McCready D, Coates A, Levine M, DePetrillo D (2001) A snapshot of waiting times for cancer surgery provided by surgeons affiliated with regional cancer centres in Ontario. Can Med Assoc J 165:421–425
12.
Wong CK, Law W-L, Wan Y-F, Poon JT-C, Lam CL-K (2014) Health-related quality of life and risk of colorectal cancer recurrence and all-cause death among advanced stages of colorectal cancer 1-year after diagnosis. BMC Cancer 14:337
13.
Moug SJ, Mutrie N, Barry SJE et al (2019) Prehabilitation is feasible in patients with rectal cancer undergoing neoadjuvant chemoradiotherapy and may minimize physical deterioration: results from the REx trial. Colorectal dis 21(5):548–562CrossRef
14.
Lai CW, Minto G, Challand CP et al (2013) Patients’ inability to perform a preoperative cardiopulmonary exercise test or demonstrate an anaerobic threshold is associated with inferior outcomes after major colorectal surgery. Br J Anaesth 111:607–611CrossRef
15.
West MA, Lythgoe D, Barben CP et al (2014) Cardiopulmonary exercise variables are associated with postoperative morbidity after major colonic surgery: a prospective blinded observational study. Br J Anaesth 112:665–671CrossRef
16.
West MA, Parry MG, Lythgoe D et al (2014) Cardiopulmonary exercise testing for the prediction of morbidity risk after rectal cancer surgery. Br J Surg 101:1166–1172CrossRef
17.
Singh F et al (2013) A systematic review of pre-surgical exercise intervention studies with cancer patients. Surg Oncol 22(2):92–104CrossRef
18.
Moyer R et al (2017) The value of preoperative exercise and education for patients undergoing total hip and knee arthroplasty: a systematic review and meta-analysis. JBJS Rev 5(12):e2
19.
Heger P, Probst P, Wiskemann J et al (2019) A systematic review and meta-analysis of physical exercise prehabilitation in major abdominal surgery (PROSPERO 2017 CRD42017080366). J Gastrointest Surg
20.
Alejo LB, Pagola-Aldazabal I, Fiuza-Luces C et al (2019) Exercise prehabilitation program for patients under neoadjuvant treatment for rectal cancer: a pilot study. J Cancer Res Ther 15(1):20–25PubMed
21.
Heldens AF, Bongers BC, de-Vos-Geelen J et al (2016) Feasibility and preliminary effectiveness of a physical exercise training program during neoadjuvant chemoradiotherapy in individual patients with rectal cancer prior to major elective surgery. Eur J Surg Oncol 42(9):1322–1330CrossRef
22.
Loughney L, West MA, Dimitrov B et al (2017) Physical activity levels in locally advanced rectal cancer patients following neoadjuvant chemoradiotherapy and an exercise training programme before surgery: a pilot study. Perioper Med (Lond) 6:3CrossRef
23.
Singh F, Galvao D, Newton R et al (2018) Feasibility and preliminary efficacy of a 10-week resistance and aerobic exercise intervention during neoadjuvant chemoradiation treatment in rectal cancer patients. Integr Cancer Ther 17(3):952–959CrossRef
24.
Singh F, Galvao D, Newton R et al (2017) Feasibility and efficacy of presurgical exercise in survivors or rectal cancer scheduled to receive curative resection. Clin Colorectal Cancer 16(4):358–365CrossRef
25.
West MA, Loughney L, Lythgoe D et al (2015) Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth 114(2):244–251CrossRef
26.
West MA, Astin R, Moyses HE et al (2019) Exercise prehabilitation may lead to augmented tumor regression following neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Acta Oncol 58(5):588–595CrossRef
27.
Moug SJ, Barry SJE, Maguire S et al (2020) Does prehabilitation modify muscle mass in patients with rectal cancer undergoing neoadjuvant therapy? A subanalysis from the REx randomised controlled trial. Tech Coloproctol 24(9):959–964CrossRef
28.
Hijazi Y, Gondal U, Aziz O (2017) A systematic review of prehabilitation programs in abdominal cancer surgery. Int J Surg 39:156–162CrossRef
29.
Orange ST, Northgraves MJ, Marshall P et al (2018) Exercise prehabilitation in elective intra-cavity surgery: a role within the ERAS pathway? A narrative review Int J Surg 56:328–333PubMed
30.
Strous MT, Janssen-Heijnen ML, Vogelaar FJ (2019) Impact of therapeutic delay in colorectal cancer on overall survival and cancer recurrence – is there a safe timeframe for prehabilitation? Eur J Surg Oncol 45(12):2295–2301CrossRef
Metadaten
Titel
Prehabilitation in rectal surgery: a narrative review
verfasst von
E. Hannan
M. E. Kelly
M. R. Fahy
D. C. Winter
Publikationsdatum
10.01.2022
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 2/2022
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-021-04092-5

Weitere Artikel der Ausgabe 2/2022

The treatment of acute appendicitis in two age-based groups during COVID-19 pandemic: a retrospective experience in a COVID-19 referral hospital

  • Zur Zeit gratis
  • COVID-19
  • Original Article

Comparison of safety and efficacy of fluorouracil + oxaliplatin + irinotecan (FOLFOXIRI) and modified FOLFOXIRI with bevacizumab for metastatic colorectal cancer: data from clinical practice

  • Original Article

Correction to: The treatment of acute appendicitis in two age‑based groups during COVID‑19 pandemic: a retrospective experience in a COVID‑19 referral hospital

Disease activity in inflammatory bowel disease patients is associated with increased liver fat content and liver fibrosis during follow-up

  • Original Article

Combining the quantitative faecal immunochemical test and full blood count reliably rules out colorectal cancer in a symptomatic patient referral pathway

  • Open Access
  • Original Article

Endoscopic vacuum therapy for the treatment of colorectal leaks — a systematic review and meta-analysis

  • Open Access
  • Review

Neu im Fachgebiet Chirurgie

Leitlinienkonformes Management thermischer Verletzungen

Thermische Verletzungen gehören zu den schwerwiegendsten Traumen und hinterlassen oft langfristige körperliche und psychische Spuren. Die aktuelle S2k-Leitlinie „Behandlung thermischer Verletzungen im Kindesalter (Verbrennung, Verbrühung)“ bietet eine strukturierte Übersicht über das empfohlene Vorgehen.

Verbände und Cremes gegen Dekubitus: „Wir wissen nicht, was sie bringen!“

Die Datenlage zur Wirksamkeit von Verbänden oder topischen Mitteln zur Prävention von Druckgeschwüren sei schlecht, so die Verfasser einer aktuellen Cochrane-Studie. Letztlich bleibe es unsicher, ob solche Maßnahmen den Betroffenen nutzen oder schaden.

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

US-Team empfiehlt Gastropexie nach Hiatushernien-Op.

Zur Vermeidung von Rezidiven nach Reparatur einer paraösophagealen Hiatushernie sollte einem US-Team zufolge der Magen bei der Op. routinemäßig an der Bauchwand fixiert werden. Das Ergebnis einer randomisierten Studie scheint dafür zu sprechen.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise