Surgery of Upper Gastrointestinal Tract Cancer
Conditions
Brief summary
Patients receiving surgery of upper gastrointestinal tract are often elderly, frail, malnourished, with poor functional reserve. They are associated with poor post-operative outcomes. This multimodal treatment is associated with considerable morbidity and decline of patients' functional capacity due to sarcopenia and malnutrition. The poor outcomes can lead to a prolonged delayed recovery, hospital stay, and disability. The post-operative morbidity, especially cardiopulmonary complications, remains substantial. Prehabilitation before surgery can improve the functional capacity of patients to better withstand the stress of surgery. In this perspective, prehabilitation has gained increasing popularity as it consists of various interventions that aim to optimize patient's preoperative condition. The rehabilitation programmes varies considerably. To maximise the benefits that can be accrued in the pre-operative period, prehabilitation programmes should be multimodal, including exercise and nutritional support. Increasing the maximal aerobic capacity by training before surgery, improves patients' functional capacity and should allow patients to better withstand the postoperative stress response. Prehabilitation has been trialled in a range of surgical specialities, including colorectal, breast, hepatobiliary, bariatric, urological, thoracic, and orthopaedic surgery. In major abdominal surgery, multiple studies have indicated that prehabilitation improved preoperative functional capacity and postoperative outcomes. There is a large body of evidence for prehabilitation in patients undergoing intra-abdominal surgery, with studies reporting improvements in pre-operative cardiopulmonary fitness, and reductions in post-operative complications. The data on prehabilitation after surgery for upper gastrointestinal tract are scarce and ambiguous and these studies often lacked a multimodal approach. The evidence of prehabilitation in Taiwan is scarce also. Surgery for upper gastrointestinal tract has a high morbidity and is associated with a prolonged recovery so there is significant potential to improve outcomes in this high-risk population. However, there are few studies of prehabilitation in surgery for upper gastrointestinal tract. Hence, this study aimed to investigate the effect of a multimodal personalised, prehabilitation program on postoperative recovery and morbidity in patients undergoing surgery for upper gastrointestinal tract.
Interventions
OTHERPrehabilitation
A personalised, home-based exercise programme was prescribed by a physical therapist. In keeping with WHO guidelines, patients were prescribed a minimum of 600 MET minutes week-1, which equates to 150 min of moderate intensity activity, with the aim of increasing this to 1200 MET minutes week-1 (300 min of moderate intensity activity). Patients were prescribed a mixture of aerobic and strength exercises, each with a defined frequency, intensity, and duration. Patients received training on how to undertake the exercises and how to selfregulate the intensity using the Borg scale rating of perceived exertion (RPE), with a target range of 13 to 15 depending on the patient's medical history and type of exercise. A specialist dietitian undertook an assessment of nutritional status including identification and stratification of nutritional risk. A plan was agreed based on symptoms, dietary eating habits, and nutritional deficiencies.
Sponsors
Taichung Tzu Chi Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* aged ≥ 18 years * with a diagnosis of potentially resectable upper gastrointestinal tract cancer
Exclusion criteria
* inability to give informed consent * non resectable disease * patients who declined surgery
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Length of hospital stay | From enrollment to the end of treatment at 8 weeks |
| 30-day readmission rate | From enrollment to the end of treatment at 12 weeks |
| Pulmonary complications | From enrollment to the end of treatment at 8 weeks |
| Anastomotic leakage rate | From enrollment to the end of treatment at 8 weeks |
| Severity (Clavien-Dindo) of complications | From enrollment to the end of treatment at 8 weeks |
Countries
Taiwan
Contacts
CONTACTChi-Wen Lin
Outcome results
None listed