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
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 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
Erweiterte Suche
Anmelden
nach oben
Current Anesthesiology Reports
Erschienen in: Current Anesthesiology Reports 4/2018

01.12.2018 | Cancer Anesthesia (B Riedel and V Gottumukkala, Section Editors)

Prehabilitation Prior to Major Cancer Surgery: Training for Surgery to Optimize Physiologic Reserve to Reduce Postoperative Complications

verfasst von: Hilmy Ismail, Prue Cormie, Kate Burbury, Jamie Waterland, Linda Denehy, Bernhard Riedel

Erschienen in: Current Anesthesiology Reports | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

The aging, sedentary global population and associated increasing incidence of cancer calls for increasingly complex surgery. These patients are at particular risk of postoperative complications. This review will explore the redesign of the perioperative care pathway, with emphasis on preoperative risk stratification to identify modifiable risk, to implement risk mitigation strategies (e.g., prehabilitation), and to partner with patients to enhance recovery after surgery.

Recent Findings

In the last decade, there has been a growing body of literature surrounding prehabilitation. A number of these studies report a staggering halving of postoperative complications. This body of literature requires perioperative medicine clinicians to appraise and build on the robustness of the data and to consider pragmatic strategies toward implementation of what appears to be a cost-effective intervention.

Summary

A redesign of perioperative care pathways with early risk stratification and implementing risk mitigation strategies is essential to delivering on the value proposition of healthcare. Challenges include a redesign of funding models to deliver such services, engaging patients with relatively remote access to such services, and the cultural trends of sedentary lifestyles and perceived urgency to have immediate surgery at all costs.
Literatur
1.
Silver JK, Baima J. Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes. Am J Phys Med Rehabil. 2013;92(8):715–27.PubMedCrossRef
2.
•• Boden I, Skinner EH, Browning L, Reeve J, Anderson L, Hill C, et al. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. BMJ. 2018;360:j5916 Randomised Controlled Trial demonstrating how a package of respiratory prehabilitation including education and instructions can reduce postoperative pulmonary complications by almost 50% in patients presenting for major abdominal surgery.PubMedPubMedCentralCrossRef
3.
•• Carli F, Silver JK, Feldman LS, McKee A, Gilman S, Gillis C, et al. Surgical prehabilitation in patients with Cancer: state-of-the-science and recommendations for future research from a panel of subject matter experts. Phys Med Rehabil Clin N Am. 2017;28(1):49–64Excellent narative review of the current research and clinical utility of prehabilitation by a group of reserachers who are among the leaders in this field internationally.PubMedCrossRef
4.
Plumb JO, Otto JM, Grocott MP. ‘Blood doping’ from Armstrong to prehabilitation: manipulation of blood to improve performance in athletes and physiological reserve in patients. Extrem Physiol Med. 2016;5:5.PubMedPubMedCentralCrossRef
5.
Gillis C, Loiselle SE, Fiore JF Jr, Awasthi R, Wykes L, Liberman AS, et al. Prehabilitation with whey protein supplementation on perioperative functional exercise capacity in patients undergoing colorectal resection for cancer: a pilot double-blinded randomized placebo-controlled trial. J Acad Nutr Diet. 2016;116(5):802–12.
6.
Tsimopoulou I, Pasquali S, Howard R, Desai A, Gourevitch D, Tolosa I, et al. Psychological prehabilitation before cancer surgery: a systematic review. Ann Surg Oncol. 2015;22(13):4117–23.
7.
Carli F, Gillis C, Scheede-Bergdahl C. Promoting a culture of prehabilitation for the surgical cancer patient. Acta Oncol. 2017;56(2):128–33.PubMedCrossRef
8.
Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242(3):326–41 discussion 41-3.PubMedPubMedCentralCrossRef
9.
Govaert JA, Fiocco M, van Dijk WA, Scheffer AC, de Graaf EJ, Tollenaar RA, et al. Costs of complications after colorectal cancer surgery in the Netherlands: building the business case for hospitals. Eur J Surg Oncol. 2015;41(8):1059–67.PubMedCrossRef
10.
Vascular Events In Noncardiac Surgery Patients Cohort Evaluation Study I, Devereaux PJ, Chan MT, Alonso-Coello P, Walsh M, Berwanger O, et al. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2012;307(21):2295–304.CrossRef
11.
Aloia TA, Zimmitti G, Conrad C, Gottumukalla V, Kopetz S, Vauthey JN. Return to intended oncologic treatment (RIOT): a novel metric for evaluating the quality of oncosurgical therapy for malignancy. J Surg Oncol. 2014;110(2):107–14.PubMedPubMedCentralCrossRef
12.
Jones LW, Haykowsky MJ, Swartz JJ, Douglas PS, Mackey JR. Early breast cancer therapy and cardiovascular injury. J Am Coll Cardiol. 2007;50(15):1435–41.PubMedCrossRef
13.
Davies SJ, Wilson RJ. Preoperative optimization of the high-risk surgical patient. Br J Anaesth. 2004;93(1):121–8.PubMedCrossRef
14.
Moonesinghe SR, Mythen MG, Grocott MP. High-risk surgery: epidemiology and outcomes. Anesth Analg. 2011;112(4):891–901.PubMedCrossRef
15.
16.
Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338–50.PubMedCrossRef
17.
Dronkers JJ, Chorus AM, van Meeteren NL, Hopman-Rock M. The association of pre-operative physical fitness and physical activity with outcome after scheduled major abdominal surgery. Anaesthesia. 2013;68(1):67–73.PubMedCrossRef
18.
Kupeli E, Er Dedekarginoglu B, Ulubay G, Oner Eyuboglu F, Haberal M. American Society of Anesthesiologists classification versus ARISCAT risk index: predicting pulmonary complications following renal transplant. Exp Clin Transplant. 2017;15(Suppl 1):208–13.PubMed
19.
Wijeysundera DN, Pearse RM, Shulman MA, Abbott TEF, Torres E, Ambosta A, et al. Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study. Lancet. 2018;391(10140):2631–40.
20.
Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, et al. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013;217(5):833–42 e1–3.PubMedPubMedCentralCrossRef
21.
22.
23.
Visnjevac O, Davari-Farid S, Lee J, Pourafkari L, Arora P, Dosluoglu HH, et al. The effect of adding functional classification to ASA status for predicting 30-day mortality. Anesth Analg. 2015;121(1):110–6.
24.
Shulman MA, Thompson BR. Not fit for a haircut ... how should we assess fitness and stratify risk for surgery? Br J Anaesth. 2014;112(6):955–7.PubMedCrossRef
25.
Lee CHA, Kong JC, Ismail H, Riedel B, Heriot A. Systematic review and meta-analysis of objective assessment of physical fitness in patients undergoing colorectal cancer surgery. Dis Colon Rectum. 2018;61(3):400–9.PubMedCrossRef
26.
Nagamatsu Y, Shima I, Yamana H, Fujita H, Shirouzu K, Ishitake T. Preoperative evaluation of cardiopulmonary reserve with the use of expired gas analysis during exercise testing in patients with squamous cell carcinoma of the thoracic esophagus. J Thorac Cardiovasc Surg. 2001;121(6):1064–8.PubMedCrossRef
27.
Moran J, Wilson F, Guinan E, McCormick P, Hussey J, Moriarty J. Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review. Br J Anaesth. 2016;116(2):177–91.PubMedCrossRef
28.
Jones LW, Watson D, Herndon JE 2nd, Eves ND, Haithcock BE, Loewen G, et al. Peak oxygen consumption and long-term all-cause mortality in nonsmall cell lung cancer. Cancer. 2010;116(20):4825–32.PubMedCrossRef
29.
West MA, Asher R, Browning M, Minto G, Swart M, Richardson K, et al. Validation of preoperative cardiopulmonary exercise testing-derived variables to predict in-hospital morbidity after major colorectal surgery. Br J Surg. 2016;103(6):744–52.
30.
Wilson RJ, Davies S, Yates D, Redman J, Stone M. Impaired functional capacity is associated with all-cause mortality after major elective intra-abdominal surgery. Br J Anaesth. 2010;105(3):297–303.PubMedCrossRef
31.
Howell SJ. Predicting survival after surgery: a matter of life and death. Anaesthesia. 2015;70(6):637–40.PubMedCrossRef
32.
Van Blarigan EL, Fuchs CS, Niedzwiecki D, Zhang S, Saltz LB, Mayer RJ, et al. Association of survival with adherence to the American Cancer Society nutrition and physical activity guidelines for Cancer survivors after colon cancer diagnosis: the CALGB 89803/Alliance trial. JAMA Oncol. 2018;4(6):783–90.PubMedPubMedCentralCrossRef
33.
Cormie P, Zopf EM, Zhang X, Schmitz KH. The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev. 2017;39(1):71–92.PubMedCrossRef
34.
Gunnell AS, Joyce S, Tomlin S, Taaffe DR, Cormie P, Newton RU, et al. Physical activity and survival among long-term cancer survivor and non-cancer cohorts. Front Public Health. 2017;5:19.PubMedPubMedCentralCrossRef
35.
Cormie P, Atkinson M, Bucci L, Cust A, Eakin E, Hayes S, et al. Clinical Oncology Society of Australia position statement on exercise in cancer care. Med J Aust. 2018;209(4):184–7.
36.
Arem H, Pfeiffer RM, Engels EA, Alfano CM, Hollenbeck A, Park Y, et al. Pre- and postdiagnosis physical activity, television viewing, and mortality among patients with colorectal cancer in the National Institutes of Health-AARP diet and health study. J Clin Oncol. 2015;33(2):180–8.
37.
Myers JN, Fonda H. The impact of fitness on surgical outcomes: the case for prehabilitation. Curr Sports Med Rep. 2016;15(4):282–9.PubMedCrossRef
38.
Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, et al. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surgery. 2016;160(5):1189–201.
39.
Jones LW, Liang Y, Pituskin EN, Battaglini CL, Scott JM, Hornsby WE, et al. Effect of exercise training on peak oxygen consumption in patients with cancer: a meta-analysis. Oncologist. 2011;16(1):112–20.
40.
Li C, Carli F, Lee L, Charlebois P, Stein B, Liberman AS, et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc. 2013;27(4):1072–82.
41.
Minnella EM, Awasthi R, Loiselle SE, Agnihotram RV, Ferri LE, Carli F. Effect of exercise and nutrition prehabilitation on functional capacity in esophagogastric cancer surgery: a randomized clinical trial. JAMA Surg. 2018.
42.
• West MA, Loughney L, Lythgoe D, Barben CP, Sripadam R, Kemp GJ, et al. Effect of prehabilitation on objectively measured physical fitness after neoadjuvant treatment in preoperative rectal cancer patients: a blinded interventional pilot study. Br J Anaesth. 2015;114(2):244–51Landmark study demonstrating the feasibilty, safety and eficacy of exercise preahbilitation in the context of colorectal surgery.PubMedCrossRef
43.
Valkenet K, Trappenburg JCA, Ruurda JP, Guinan EM, Reynolds JV, Nafteux P, et al. Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer. Br J Surg. 2018;105(5):502–11.
44.
West MA, Loughney L, Ambler G, Dimitrov BD, Kelly JJ, Mythen MG, et al. The effect of neoadjuvant chemotherapy and chemoradiotherapy on exercise capacity and outcome following upper gastrointestinal cancer surgery: an observational cohort study. BMC Cancer. 2016;16(1):710.
45.
West MA, Loughney L, Barben CP, Sripadam R, Kemp GJ, Grocott MP, et al. The effects of neoadjuvant chemoradiotherapy on physical fitness and morbidity in rectal cancer surgery patients. Eur J Surg Oncol. 2014;40(11):1421–8.PubMedCrossRef
46.
Fry BT, Hallway A, Englesbe MJ. Moving toward every patient training for surgery. JAMA Surg. 2018.
47.
Huang GH, Ismail H, Murnane A, Kim P, Riedel B. Structured exercise program prior to major cancer surgery improves cardiopulmonary fitness: a retrospective cohort study. Support Care Cancer. 2016;24(5):2277–85.PubMedCrossRef
48.
Carli F, Charlebois P, Stein B, Feldman L, Zavorsky G, Kim DJ, et al. Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg. 2010;97(8):1187–97.
49.
Braga M, Ljungqvist O, Soeters P, Fearon K, Weimann A, Bozzetti F, et al. ESPEN guidelines on parenteral nutrition: surgery. Clin Nutr. 2009;28(4):378–86.
50.
Schwegler I, von Holzen A, Gutzwiller JP, Schlumpf R, Muhlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010;97(1):92–7.
51.
Gillis C, Nguyen TH, Liberman AS, Carli F. Nutrition adequacy in enhanced recovery after surgery: a single academic center experience. Nutr Clin Pract. 2015;30(3):414–9.PubMedCrossRef
52.
Benoist S, Brouquet A. Nutritional assessment and screening for malnutrition. J Visc Surg. 2015;152(Suppl 1):S3–7.PubMedCrossRef
53.
Kubota K, Kuroda J, Yoshida M, Okada A, Deguchi T, Kitajima M. Preoperative oral supplementation support in patients with esophageal cancer. J Nutr Health Aging. 2014;18(4):437–40.PubMedCrossRef
54.
Kabata P, Jastrzebski T, Kakol M, Krol K, Bobowicz M, Kosowska A, et al. Preoperative nutritional support in cancer patients with no clinical signs of malnutrition—prospective randomized controlled trial. Support Care Cancer. 2015;23(2):365–70.PubMedCrossRef
55.
Gillis C, Fenton TR, Sajobi TT, Minnella EM, Awasthi R, Loiselle SE, et al. Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: a pooled analysis of randomized controlled trials. Clin Nutr. 2018.
56.
Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, et al. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesth Analg. 2018;126(6):1883–95.
57.
Khanbhai M, Shah M, Cantanhede G, Ilyas S, Richards T. The problem of anaemia in patients with colorectal cancer. ISRN Hematol. 2014;2014:547914.PubMedPubMedCentralCrossRef
58.
Ludwig H, Muldur E, Endler G, Hubl W. Prevalence of iron deficiency across different tumors and its association with poor performance status, disease status and anemia. Ann Oncol. 2013;24(7):1886–92.PubMedPubMedCentralCrossRef
59.
Musallam KM, Tamim HM, Richards T, Spahn DR, Rosendaal FR, Habbal A, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378(9800):1396–407.
60.
Ng O, Keeler BD, Mishra A, Simpson A, Neal K, Brookes MJ, et al. Iron therapy for pre-operative anaemia. Cochrane Database Syst Rev. 2015;12:CD011588.
61.
Okonko DO, Grzeslo A, Witkowski T, Mandal AK, Slater RM, Roughton M, et al. Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency FERRIC-HF: a randomized, controlled, observer-blinded trial. J Am Coll Cardiol. 2008;51(2):103–12.PubMedCrossRef
62.
Wright SE, Pearce B, Snowden CP, Anderson H, Wallis JP. Cardiopulmonary exercise testing before and after blood transfusion: a prospective clinical study. Br J Anaesth. 2014;113(1):91–6.PubMedCrossRef
63.
Tonelli M, Hemmelgarn B, Reiman T, Manns B, Reaume MN, Lloyd A, et al. Benefits and harms of erythropoiesis-stimulating agents for anemia related to cancer: a meta-analysis. CMAJ. 2009;180(11):E62–71.
64.
Gillis C, Li C, Lee L, Awasthi R, Augustin B, Gamsa A, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014;121(5):937–47.
65.
Chen BP, Awasthi R, Sweet SN, Minnella EM, Bergdahl A, Santa Mina D, et al. Four-week prehabilitation program is sufficient to modify exercise behaviors and improve preoperative functional walking capacity in patients with colorectal cancer. Support Care Cancer. 2017;25(1):33–40.
66.
Barberan-Garcia A, Rodriguez DA, Blanco I, Gea J, Torralba Y, Arbillaga-Etxarri A, et al. Non-anaemic iron deficiency impairs response to pulmonary rehabilitation in COPD. Respirology. 2015;20(7):1089–95.PubMedCrossRef
67.
Moore JA, Conway DH, Thomas N, Cummings D, Atkinson D. Impact of a peri-operative quality improvement programme on postoperative pulmonary complications. Anaesthesia. 2017;72(3):317–27.PubMedCrossRef
68.
Kim DJ, Mayo NE, Carli F, Montgomery DL, Zavorsky GS. Responsive measures to prehabilitation in patients undergoing bowel resection surgery. Tohoku J Exp Med. 2009;217(2):109–15.PubMedCrossRef
69.
Jones LW, Eves ND, Haykowsky M, Freedland SJ, Mackey JR. Exercise intolerance in cancer and the role of exercise therapy to reverse dysfunction. Lancet Oncol. 2009;10(6):598–605.PubMedCrossRef
70.
Carli F, Scheede-Bergdahl C. Prehabilitation to enhance perioperative care. Anesthesiol Clin. 2015;33(1):17–33.PubMedCrossRef
71.
Mujika I, Padilla S. Muscular characteristics of detraining in humans. Med Sci Sports Exerc. 2001;33(8):1297–303.PubMedCrossRef
72.
Murillo R, Albendea C, Penagos I, Marin C, Rivero T, Ruiz B, et al. Inflammatory response modulation by prehabilitation therapy in colonic surgery. Clin Nutr ESPEN. 2016;12:e54.CrossRef
73.
Scott JM, Khakoo A, Mackey JR, Haykowsky MJ, Douglas PS, Jones LW. Modulation of anthracycline-induced cardiotoxicity by aerobic exercise in breast cancer: current evidence and underlying mechanisms. Circulation. 2011;124(5):642–50.PubMedPubMedCentralCrossRef
74.
Sebio Garcia R, Yanez Brage MI, Gimenez Moolhuyzen E, Granger CL, Denehy L. Functional and postoperative outcomes after preoperative exercise training in patients with lung cancer: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg. 2016;23(3):486–97.PubMedCrossRef
75.
Steffens D, Beckenkamp PR, Hancock M, Solomon M, Young J. Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer. Br J Sports Med. 2018;52(5):344.PubMedCrossRef
76.
Bolshinsky V, Li MH, Ismail H, Burbury K, Riedel B, Heriot A. Multimodal prehabilitation programs as a bundle of care in gastrointestinal cancer surgery: a systematic review. Dis Colon Rectum. 2018;61(1):124–38.PubMedCrossRef
77.
Brasher PA, McClelland KH, Denehy L, Story I. Does removal of deep breathing exercises from a physiotherapy program including pre-operative education and early mobilisation after cardiac surgery alter patient outcomes? Aust J Physiother. 2003;49(3):165–73.PubMedCrossRef
78.
Boden I, El-Ansary D, Zalucki N, Robertson IK, Browning L, Skinner EH, et al. Physiotherapy education and training prior to upper abdominal surgery is memorable and has high treatment fidelity: a nested mixed-methods randomised-controlled study. Physiotherapy. 2017.
79.
•• Barberan-Garcia A, Ubre M, Roca J, Lacy AM, Burgos F, Risco R, et al. Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: a randomized blinded controlled trial. Ann Surg. 2018;267(1):50–6 Randomized blinded controlled trial assessing the impact of a prehabilitation intervention in high-risk patients undergoing major abdominal surgery, demonstrating a 51% reduction in postoperative complications and significant reduction in cardiac complications and length of ICU stay.PubMedCrossRef
80.
•• Barakat HM, Shahin Y, Khan JA, PT MC, Chetter IC. Preoperative supervised exercise improves outcomes after elective abdominal aortic aneurysm repair: a randomized controlled trial. Ann Surg. 2016;264(1):47–53 Randomized controlled trial assessing the impact of an exercise prehabilitation intervention in high-risk patients undergoing major vascular surgery, demonstrating an improvement in peakVO2, 50% reduction in postoperative complications and significant reduction in hospital stay.PubMedCrossRef
81.
82.
Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, et al. How we design feasibility studies. Am J Prev Med. 2009;36(5):452–7.
83.
Cassidy MR, Rosenkranz P, McCabe K, Rosen JE, McAneny D. I COUGH: reducing postoperative pulmonary complications with a multidisciplinary patient care program. JAMA Surg. 2013;148(8):740–5.PubMedCrossRef
84.
Boereboom CL, Williams JP, Leighton P, Lund JN. Exercise prehabilitation in colorectal cancer Delphi study G. forming a consensus opinion on exercise prehabilitation in elderly colorectal cancer patients: a Delphi study. Tech Coloproctol. 2015;19(6):347–54.PubMedCrossRef
85.
Boney O, Bell M, Bell N, Conquest A, Cumbers M, Drake S, et al. Identifying research priorities in anaesthesia and perioperative care: final report of the joint National Institute of academic Anaesthesia/James Lind Alliance research priority setting partnership. BMJ Open. 2015;5(12):e010006.
86.
Barberan-Garcia A, Gimeno-Santos E, Blanco I, Cano I, Martinez-Palli G, Burgos F, et al. Protocol for regional implementation of collaborative self-management services to promote physical activity. BMC Health Serv Res. 2018;18(1):560.PubMedPubMedCentralCrossRef
87.
Jack S WM. The Wessex Fit-4-Cancer surgery trial (WesFit). 2018.
88.
Guazzi M, Arena R, Halle M, Piepoli MF, Myers J, Lavie CJ. 2016 focused update: clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations. Circulation. 2016;133(24):e694–711.PubMedCrossRef
Metadaten
Titel
Prehabilitation Prior to Major Cancer Surgery: Training for Surgery to Optimize Physiologic Reserve to Reduce Postoperative Complications
verfasst von
Hilmy Ismail
Prue Cormie
Kate Burbury
Jamie Waterland
Linda Denehy
Bernhard Riedel
Publikationsdatum
01.12.2018
Verlag
Springer US
Erschienen in
Current Anesthesiology Reports / Ausgabe 4/2018
Elektronische ISSN: 2167-6275
DOI
https://doi.org/10.1007/s40140-018-0300-7

Weitere Artikel der Ausgabe 4/2018

Current Anesthesiology Reports 4/2018 Zur Ausgabe

Pain Medicine (GJ Meredith, Section Editor)

New Advances in Neuromodulation

Cancer Anesthesia (B Riedel and V Gottumukkala, Section Editors)

Transfusion Therapy: Is There a Link with Cancer Recurrence?

Cancer Anesthesia (B Riedel and V Gottumukkala, Section Editors)

Organization of Multidisciplinary Cancer Care for the Surgical Patient: Role of Anesthesiologists

Cancer Anesthesia (B Riedel and V Gottumukkala, Section Editors)

Cancer Biology: a Primer for Perioperative Clinicians

Cancer Anesthesia (B Riedel and V Gottumukkala, Section Editors)

New Cancer Therapies: Implications for the Perioperative Period

Cancer Anesthesia (B Riedel and V Gottumukkala, Section Editors)

The Effect of Anaesthetic and Analgesic Technique on Oncological Outcomes

Neu im Fachgebiet AINS

23.04.2024 | Appendizitis | Nachrichten

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 | Leitsymptom Rückenschmerzen | Nachrichten

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 | Operationsvorbereitung | Nachrichten

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 | Pankreaskarzinom | Nachrichten

S3-Leitlinie zu Pankreaskrebs aktualisiert
weitere anzeigen

Update AINS

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

hier abonnieren