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Clin Colon Rectal Surg 2019; 32(02): 095-101
DOI: 10.1055/s-0038-1676473
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Contemporary Opportunity for Prehabilitation as Part of an Enhanced Recovery after Surgery Pathway in Colorectal Surgery

Zhi Ven Fong
1   Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
,
David C. Chang
1   Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
,
Keith D. Lillemoe
2   Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
,
Ryan D. Nipp
3   Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
,
Kenneth K. Tanabe
2   Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
,
Motaz Qadan
2   Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
28 February 2019 (online)

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Abstract

The implementation of upfront, preoperative habilitation (“prehabilitation”), as opposed to postoperative habilitation (rehabilitation), provides a unique opportunity to optimize surgical outcomes, while ensuring that patients receive necessary conditioning that may otherwise be significantly delayed by postoperative complications. In this review, opportunities to design, implement, monitor, and evaluate a surgical prehabilitation program in colorectal surgery are discussed, and broken down to include emotional, physical, and nutritional aspects of care in the preoperative setting.

Keywords

prehabilitation - optimization - colorectal surgery - surgical oncology - cancer - nutrition - exercise
 

  • References

  • 1 Mirkin KA, Hollenbeak CS, Gusani NJ. , et al. Trends in utilization of neoadjuvant therapy and short-term outcomes in resected pancreatic cancer. Am J Surg 2017; 214 (01) 80-88
    CrossrefPubMedGoogle Scholar
  • 2 Greenleaf EK, Hollenbeak CS, Wong J. Trends in the use and impact of neoadjuvant chemotherapy on perioperative outcomes for resected gastric cancer: evidence from the American College of Surgeons National Cancer Database. Surgery 2016; 159 (04) 1099-1112
    CrossrefPubMedGoogle Scholar
  • 3 Bui DL, Yu JB. Trends in adjuvant and neoadjuvant radiotherapy for cancer treatment from 1973 to 2011. Cancer J 2015; 21 (03) 147-149
    CrossrefPubMedGoogle Scholar
  • 4 Arthur HM, Daniels C, McKelvie R, Hirsh J, Rush B. Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery. A randomized, controlled trial. Ann Intern Med 2000; 133 (04) 253-262
    PubMedGoogle Scholar
  • 5 Tarnopolsky MA, Atkinson SA, Phillips SM, MacDougall JD. Carbohydrate loading and metabolism during exercise in men and women. J Appl Physiol (1985) 1995; 78 (04) 1360-1368
    CrossrefPubMedGoogle Scholar
  • 6 Fa-Si-Oen P, Roumen R, Buitenweg J. , et al. Mechanical bowel preparation or not? Outcome of a multicenter, randomized trial in elective open colon surgery. Dis Colon Rectum 2005; 48 (08) 1509-1516
    CrossrefPubMedGoogle Scholar
  • 7 Lavu H, Kennedy EP, Mazo R. , et al. Preoperative mechanical bowel preparation does not offer a benefit for patients who undergo pancreaticoduodenectomy. Surgery 2010; 148 (02) 278-284
    CrossrefPubMedGoogle Scholar
  • 8 Slim K, Vicaut E, Panis Y, Chipponi J. Meta-analysis of randomized clinical trials of colorectal surgery with or without mechanical bowel preparation. Br J Surg 2004; 91 (09) 1125-1130
    CrossrefPubMedGoogle Scholar
  • 9 Bilimoria KY, Ko CY, Tomlinson JS. , et al. Wait times for cancer surgery in the United States: trends and predictors of delays. Ann Surg 2011; 253 (04) 779-785
    CrossrefPubMedGoogle Scholar
  • 10 Papalezova KT, Tyler DS, Blazer III DG. , et al. Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer?. J Surg Oncol 2012; 106 (01) 111-118
    CrossrefPubMedGoogle Scholar
  • 11 Katz MH, Wang H, Fleming JB. , et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol 2009; 16 (04) 836-847
    CrossrefPubMedGoogle Scholar
  • 12 Pawlik TM, Laheru D, Hruban RH. , et al; Johns Hopkins Multidisciplinary Pancreas Clinic Team. Evaluating the impact of a single-day multidisciplinary clinic on the management of pancreatic cancer. Ann Surg Oncol 2008; 15 (08) 2081-2088
    CrossrefPubMedGoogle Scholar
  • 13 Bilimoria KY, Bentrem DJ, Ko CY. , et al. Multimodality therapy for pancreatic cancer in the U.S.: utilization, outcomes, and the effect of hospital volume. Cancer 2007; 110 (06) 1227-1234
    CrossrefPubMedGoogle Scholar
  • 14 Gianotti L, Braga M, Nespoli L, Radaelli G, Beneduce A, Di Carlo V. A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer. Gastroenterology 2002; 122 (07) 1763-1770
    CrossrefPubMedGoogle Scholar
  • 15 Alem N, Rinehart J, Lee B. , et al. A case management report: a collaborative perioperative surgical home paradigm and the reduction of total joint arthroplasty readmissions. Perioper Med (Lond) 2016; 5: 27
    CrossrefPubMedGoogle Scholar
  • 16 McMurray A, Johnson P, Wallis M, Patterson E, Griffiths S. General surgical patients' perspectives of the adequacy and appropriateness of discharge planning to facilitate health decision-making at home. J Clin Nurs 2007; 16 (09) 1602-1609
    CrossrefPubMedGoogle Scholar
  • 17 Ceppa EP, Pitt HA, Nakeeb A. , et al. Reducing readmissions after pancreatectomy: limiting complications and coordinating the care continuum. J Am Coll Surg 2015; 221 (03) 708-716
    CrossrefPubMedGoogle Scholar
  • 18 Strong for Surgery, Optimizing Health Prior to Surgery. 2016 . Available at: http://www.becertain.org/strong_for_surgery/about . Accessed July 30, 2018
    PubMed
  • 19 Hoyt DB. Looking forward – April 2015 2015. Available at: http://bulletin.facs.org/2015/04/looking-forward-april-2015/ . Accessed July 11, 2016
    PubMedGoogle Scholar
  • 20 Englesbe MJ, Lussiez AD, Friedman JF, Sullivan JA, Wang SC. Starting a surgical home. Ann Surg 2015; 262 (06) 901-903
    CrossrefPubMedGoogle Scholar
  • 21 Dikken C, Sitzia J. Patients' experiences of chemotherapy: side-effects associated with 5-fluorouracil + folinic acid in the treatment of colorectal cancer. J Clin Nurs 1998; 7 (04) 371-379
    CrossrefPubMedGoogle Scholar
  • 22 Marijnen CA, Kapiteijn E, van de Velde CJ. , et al; Cooperative Investigators of the Dutch Colorectal Cancer Group. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2002; 20 (03) 817-825
    CrossrefPubMedGoogle Scholar
  • 23 Jones LW, Peddle CJ, Eves ND. , et al. Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer 2007; 110 (03) 590-598
    CrossrefPubMedGoogle Scholar
  • 24 Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy on postoperative outcome: a systematic review. Clin Rehabil 2011; 25 (02) 99-111
    CrossrefPubMedGoogle Scholar
  • 25 Mayo NE, Feldman L, Scott S. , et al. Impact of preoperative change in physical function on postoperative recovery: argument supporting prehabilitation for colorectal surgery. Surgery 2011; 150 (03) 505-514
    CrossrefPubMedGoogle Scholar
  • 26 Makary MA, Winter JM, Cameron JL. , et al. Pancreaticoduodenectomy in the very elderly. J Gastrointest Surg 2006; 10 (03) 347-356
    CrossrefPubMedGoogle Scholar
  • 27 Bentrem DJ, Cohen ME, Hynes DM, Ko CY, Bilimoria KY. Identification of specific quality improvement opportunities for the elderly undergoing gastrointestinal surgery. Arch Surg 2009; 144 (11) 1013-1020
    PubMedGoogle Scholar
  • 28 Riall TS, Reddy DM, Nealon WH, Goodwin JS. The effect of age on short-term outcomes after pancreatic resection: a population-based study. Ann Surg 2008; 248 (03) 459-467
    CrossrefPubMedGoogle Scholar
  • 29 Marrelli D, Roviello F, De Stefano A. , et al. Surgical treatment of gastrointestinal carcinomas in octogenarians: risk factors for complications and long-term outcome. Eur J Surg Oncol 2000; 26 (04) 371-376
    CrossrefPubMedGoogle Scholar
  • 30 Louis DJ, Hsu A, Brand MI, Saclarides TJ. Morbidity and mortality in octogenarians and older undergoing major intestinal surgery. Dis Colon Rectum 2009; 52 (01) 59-63
    CrossrefPubMedGoogle Scholar
  • 31 Bakens MJ, van der Geest LG, van Putten M. , et al; Dutch Pancreatic Cancer Group. The use of adjuvant chemotherapy for pancreatic cancer varies widely between hospitals: a nationwide population-based analysis. Cancer Med 2016; 5 (10) 2825-2831
    CrossrefPubMedGoogle Scholar
  • 32 Merkow RP, Bilimoria KY, Tomlinson JS. , et al. Postoperative complications reduce adjuvant chemotherapy use in resectable pancreatic cancer. Ann Surg 2014; 260 (02) 372-377
    CrossrefPubMedGoogle Scholar
  • 33 Xia BT, Habib DA, Dhar VK. , et al. Early recurrence and omission of adjuvant therapy after pancreaticoduodenectomy argue against a surgery-first approach. Ann Surg Oncol 2016; 23 (13) 4156-4164
    CrossrefPubMedGoogle Scholar
  • 34 Tsimopoulou I, Pasquali S, Howard R. , et al. Psychological prehabilitation before cancer surgery: a systematic review. Ann Surg Oncol 2015; 22 (13) 4117-4123
    CrossrefPubMedGoogle Scholar
  • 35 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 (08) 715-727
    CrossrefPubMedGoogle Scholar
  • 36 Silver JK. Cancer prehabilitation and its role in improving health outcomes and reducing health care costs. Semin Oncol Nurs 2015; 31 (01) 13-30
    CrossrefPubMedGoogle Scholar
  • 37 Baider L, Surbone A. Universality of aging: family caregivers for elderly cancer patients. Front Psychol 2014; 5: 744
    PubMedGoogle Scholar
  • 38 Verbakel E, Metzelthin SF, Kempen GIJM. Caregiving to Older Adults: Determinants of Informal Caregivers' Subjective Well-being and Formal and Informal Support as Alleviating Conditions. J Gerontol B Psychol Sci Soc Sci 2018; 73 (06) 1099-1111
    PubMedGoogle Scholar
  • 39 Live better, Together!|PatientsLikeMe. Available at: https://www.patientslikeme.com . Accessed November 19, 2016
    PubMed
  • 40 Our Story. WePatients. The Next Generation of Online Healthcare 2016. Available at: http://www.wepatients.com . Accessed November 19, 2016
    PubMedGoogle Scholar
  • 41 Chiauzzi E, DasMahapatra P, Cochin E, Bunce M, Khoury R, Dave P. Factors in patient empowerment: a survey of an online patient research network. Patient 2016; 9 (06) 511-523
    CrossrefPubMedGoogle Scholar
  • 42 DasMahapatra P, Raja P, Gilbert J, Wicks P. Clinical trials from the patient perspective: survey in an online patient community. BMC Health Serv Res 2017; 17 (01) 166
    CrossrefPubMedGoogle Scholar
  • 43 Møller AM, Villebro N, Pedersen T, Tønnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet 2002; 359 (9301): 114-117
    CrossrefPubMedGoogle Scholar
  • 44 Marseu K, Slinger P. Peri-operative pulmonary dysfunction and protection. Anaesthesia 2016; 71 (Suppl. 01) 46-50
    CrossrefPubMedGoogle Scholar
  • 45 Carli F, Charlebois P, Stein B. , et al. Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg 2010; 97 (08) 1187-1197
    CrossrefPubMedGoogle Scholar
  • 46 Minnella EM, Bousquet-Dion G, Awasthi R, Scheede-Bergdahl C, Carli F. Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience. Acta Oncol 2017; 56 (02) 295-300
    CrossrefPubMedGoogle Scholar
  • 47 Bruns ER, van den Heuvel B, Buskens CJ. , et al. The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: a systematic review. Colorectal Dis 2016; 18 (08) O267-O277
    CrossrefPubMedGoogle Scholar
  • 48 Ljungqvist O, Nygren J, Thorell A. Modulation of post-operative insulin resistance by pre-operative carbohydrate loading. Proc Nutr Soc 2002; 61 (03) 329-336
    CrossrefPubMedGoogle Scholar
  • 49 Bilku DK, Dennison AR, Hall TC, Metcalfe MS, Garcea G. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl 2014; 96 (01) 15-22
    CrossrefPubMedGoogle Scholar
  • 50 Yuill KA, Richardson RA, Davidson HI, Garden OJ, Parks RW. The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively--a randomised clinical trial. Clin Nutr 2005; 24 (01) 32-37
    CrossrefPubMedGoogle Scholar
  • 51 Noblett SE, Watson DS, Huong H, Davison B, Hainsworth PJ, Horgan AF. Pre-operative oral carbohydrate loading in colorectal surgery: a randomized controlled trial. Colorectal Dis 2006; 8 (07) 563-569
    CrossrefPubMedGoogle Scholar
  • 52 Group EC. ; ERAS Compliance Group. The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 2015; 261 (06) 1153-1159
    CrossrefPubMedGoogle Scholar
  • 53 Awad S, Varadhan KK, Ljungqvist O, Lobo DN. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr 2013; 32 (01) 34-44
    CrossrefPubMedGoogle Scholar
  • 54 Ceppa EP, Pitt HA, House MG. , et al. Reducing surgical site infections in hepatopancreatobiliary surgery. HPB 2013; 15 (05) 384-391
    CrossrefPubMedGoogle Scholar
  • 55 Anthony T, Murray BW, Sum-Ping JT. , et al. Evaluating an evidence-based bundle for preventing surgical site infection: a randomized trial. Arch Surg 2011; 146 (03) 263-269
    PubMedGoogle Scholar
  • 56 Bird D, Zambuto A, O'Donnell C. , et al. Adherence to ventilator-associated pneumonia bundle and incidence of ventilator-associated pneumonia in the surgical intensive care unit. Arch Surg 2010; 145 (05) 465-470
    PubMedGoogle Scholar
  • 57 Galpern D, Guerrero A, Tu A, Fahoum B, Wise L. Effectiveness of a central line bundle campaign on line-associated infections in the intensive care unit. Surgery 2008; 144 (04) 492-495 , discussion 495
    CrossrefPubMedGoogle Scholar
  • 58 Marschall J, Mermel LA, Fakih M. , et al; Society for Healthcare Epidemiology of America. Strategies to prevent central line-associated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014; 35 (07) 753-771
    CrossrefPubMedGoogle Scholar
  • 59 Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J. ; Enhanced Recovery After Surgery Study Group. Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg 2011; 146 (05) 571-577
    CrossrefPubMedGoogle Scholar
  • 60 Varadhan KK, Neal KR, Dejong CH, Fearon KC, Ljungqvist O, Lobo DN. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials. Clin Nutr 2010; 29 (04) 434-440
    CrossrefPubMedGoogle Scholar
  • 61 Wu W, He J, Cameron JL. , et al. The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy for adenocarcinoma. Ann Surg Oncol 2014; 21 (09) 2873-2881
    CrossrefPubMedGoogle Scholar
  • 62 Labori KJ, Katz MH, Tzeng CW. , et al. Impact of early disease progression and surgical complications on adjuvant chemotherapy completion rates and survival in patients undergoing the surgery first approach for resectable pancreatic ductal adenocarcinoma - A population-based cohort study. Acta Oncol 2016; 55 (03) 265-277
    CrossrefPubMedGoogle Scholar
  • 63 Moran J, Guinan E, McCormick P. , et al. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis. Surgery 2016; 160 (05) 1189-1201
    CrossrefPubMedGoogle Scholar