Prehabilitation in Colorectal Cancer Surgery PDF Download
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Author: Enrico Minnella
Publisher:
ISBN:
Category :
Languages : en
Pages :
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"Prehabilitation is a preoperative intervention that aims to prevent or attenuate treatment-related functional decline and its consequences. Given the complex nature of the functional impairment of cancer patients undergoing surgery, our research group has conceptualized prehabilitation as multidisciplinary intervention, including exercise training with both endurance and resistance components, nutritional counseling with protein supplementation, and anxiety reducing strategies. In this thesis, the study population consists in patients undergoing elective colorectal surgery for non-metastatic cancer.Including four original trials and one review article, this dissertation is meant to provide a solid scientific proof in this new and fast growing field. These studies: i) demonstrate that prehabilitation is effective in preventing perioperative functional decline; ii) establish that patients with low physical status, at high-risk for poor surgical outcome, respond to greater extend to prehabilitation; iii) find an association between improved preoperative physical fitness and lower severity of postoperative complications; iv) objectively define functional the trajectory along the whole perioperative period; and v) show that high-intensity interval training is the optimal strategy to improve cardiorespiratory fitness after surgery.Taken together, conclusive evidence is provided that physical functioning could be preserved and optimized during cancer care using prehabilitation, with proven effects in high-risk population, surgical morbidity, and whole-body metabolism. I think is that this scientific finding will foster further research in the topic, and promote the implementation of evidence-based principles into cancer care"--
Author: Enrico Minnella
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Book Description
"Prehabilitation is a preoperative intervention that aims to prevent or attenuate treatment-related functional decline and its consequences. Given the complex nature of the functional impairment of cancer patients undergoing surgery, our research group has conceptualized prehabilitation as multidisciplinary intervention, including exercise training with both endurance and resistance components, nutritional counseling with protein supplementation, and anxiety reducing strategies. In this thesis, the study population consists in patients undergoing elective colorectal surgery for non-metastatic cancer.Including four original trials and one review article, this dissertation is meant to provide a solid scientific proof in this new and fast growing field. These studies: i) demonstrate that prehabilitation is effective in preventing perioperative functional decline; ii) establish that patients with low physical status, at high-risk for poor surgical outcome, respond to greater extend to prehabilitation; iii) find an association between improved preoperative physical fitness and lower severity of postoperative complications; iv) objectively define functional the trajectory along the whole perioperative period; and v) show that high-intensity interval training is the optimal strategy to improve cardiorespiratory fitness after surgery.Taken together, conclusive evidence is provided that physical functioning could be preserved and optimized during cancer care using prehabilitation, with proven effects in high-risk population, surgical morbidity, and whole-body metabolism. I think is that this scientific finding will foster further research in the topic, and promote the implementation of evidence-based principles into cancer care"--
Author: Arunangshu Chakraborty
Publisher: Springer
ISBN: 9789811664960
Category : Medical
Languages : en
Pages : 0
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Book Description
This book explores the concept of prehabilitation to great depths using all possible modes of prehabilitation across surgical specialities. Prehabilitation is a unique concept that is becoming popular day-by-day. It began from the enhanced recovery after surgery (ERAS) program and has found importance in almost all of the surgeries now. The book possibly being the first on prehabilitation globally introduces the concept, describes the methods of functional assessment of the patients scheduled for extensive cancer surgery, and ways of pre-optimisation. It covers the methods of prehabilitation system-wise and then provides pehabilitation tools specific for individual onco-surgical subspecialties. The book will be an invaluable resource for practitioners of onco-anesthesia and onco-surgery in optimizing their patients before surgery for best results. It will also be useful for the allied disciplines such as nutritionists, physiotherapists, psychiatrists and oncology nurses.
Author: Matthew James Northgraves
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Author: Stefanus Johannes Rooijen
Publisher:
ISBN: 9789463323611
Category :
Languages : en
Pages : 401
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Author: Enrico Maria Minnella
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Book Description
Multimodal Prehabilitation and Major Complications after Colorectal Surgery for Cancer: The impact of Improving Preoperative Functional Capacity.BackgroundMultidisciplinary consensus agrees on the necessity to reduce major complications after abdominal surgery, as these represent a significant burden to patients and society. Multimodal prehabilitation programs comprising physical exercise, nutritional and anxiety-coping interventions have been shown to improve perioperative functional capacity in a greater proportion of patients. The impact of this improvement on major complications has not been investigated yet. The purpose of this study is to determine whether a preoperative functional improvement reduces the incidence of major complications after colorectal surgery.MethodsThis study involved a sample of 109 participants enrolled in one pilot and two randomized controlled trials. All participant underwent a 4-week multimodal prehabilitation program before colorectal surgery. Functional capacity was assessed with a six-minute walk test, a validated measure of surgical recovery that measure the distance walked on a flat hard surface in 6 minutes (6MWD). As the minimal clinically important difference of 6MWD is estimated at 20 m, two groups were defined as follows: one included participants whose change in 6MWD from baseline was less than 20 m (n=48) and the other included those whose change in 6MWD was at least 20 m (n=61). Complication severity was graded according to the Clavienu2013Dindo classification, and those graded as IIIu2013V were defined as major. Primary outcome was the incidence of major complications. ResultsThere were no significant baseline differences between the groups for age, gender, BMI, ASA, Charlson Comorbidity Index, CR-POSSUM scores, cancer stage, surgical procedure and approach, duration of surgery and intraoperative blood loss. Participants experiencing a significant preoperative functional improvement had a lower baseline 6MWD (406.8 [IQR 377.6- 436.0] m vs. 448.0 [IQR 419.2-477.0] m, p=0.05). There were 6 (13%) major complications among subjects with a change in 6MWD below 20 m, and one (2%) in the other group (p=0.042). ConclusionPreliminary data indicate that patients who achieved a preoperative significantly improvement in functional walking capacity are more likely to have less major complications after colorectal cancer surgery.
Author: Maude Trépanier
Publisher:
ISBN:
Category :
Languages : en
Pages :
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"Introduction: Preoperative multimodal exercise and nutritional programs (prehabilitation) decrease postoperative morbidity and improve functional capacity and recovery following colorectal surgery. The effect of prehabilitation on cancer outcomes is however unknown. The objectives of this thesis were to investigate the effect of prehabilitation on survival after colorectal cancer surgery and to determine the effect of longer time from diagnosis to surgical treatment on survival after colorectal cancer surgery.Methods: First, a pooled analysis of three previous prehabilitation trials (2 RCTs, 1 cohort) in patients undergoing elective, biopsy-proven, primary non-metastatic colorectal cancer surgery from 2009-2014 within an enhanced recovery program was performed. Second, a retrospective cohort of all adult patients undergoing elective resection of primary non-metastatic colorectal adenocarcinoma from 2009-2014 were reviewed. Treatment delays were defined as time from tissue diagnosis to definitive surgery, categorized as 4, 4 to
Author: Arunangshu Chakraborty
Publisher: Springer Nature
ISBN: 9811664943
Category : Medical
Languages : en
Pages : 346
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Book Description
This book explores the concept of prehabilitation to great depths using all possible modes of prehabilitation across surgical specialities. Prehabilitation is a unique concept that is becoming popular day-by-day. It began from the enhanced recovery after surgery (ERAS) program and has found importance in almost all of the surgeries now. The book possibly being the first on prehabilitation globally introduces the concept, describes the methods of functional assessment of the patients scheduled for extensive cancer surgery, and ways of pre-optimisation. It covers the methods of prehabilitation system-wise and then provides pehabilitation tools specific for individual onco-surgical subspecialties. The book will be an invaluable resource for practitioners of onco-anesthesia and onco-surgery in optimizing their patients before surgery for best results. It will also be useful for the allied disciplines such as nutritionists, physiotherapists, psychiatrists and oncology nurses.
Author: Rashami Awasthi
Publisher:
ISBN:
Category :
Languages : en
Pages : 104
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Book Description
Exercise training has been shown to positively affect the maintenance of functional capacity and facilitate recovery from surgery. This thesis proposes that a supervised pre- operative exercise training program would encourage patient compliance, thus maximizing the opportunity to regain functional exercise capacity 4-weeks post-surgery. The supervised group (Group S) received 4 training sessions at the Montreal General Hospital exercise laboratory along with a home-based exercise program during the pre-surgical period and provided daily supervised exercise during the post-surgical hospital stay. The unsupervised group (Group U) received a 4-week home-based exercise program during the pre-surgical period and were not seen by a kinesiologist during the post-surgical in-hospital stay. The exercise programs (both pre and post-surgery) included individualized aerobic, resistance and flexibility exercises. Both groups continued to exercise until 4 weeks post-surgery, after which they returned to the laboratory for evaluation. The primary outcome was functional walking capacity, as assessed by the six-minute walk test (6MWT).
Author: Chao Li
Publisher:
ISBN:
Category :
Languages : en
Pages :
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"Background: Patients undergoing colorectal cancer resections are at risk for delayed recovery. A previous prehabilitation program using exercise alone has shown limited impact in enhancing functional capacity and recovery. We compared the impact of a new trimodal prehabilitation program which includes exercise, nutritional and psychological therapy to patients undergoing standard care. Literature Review: Limited literature exists in enhancing functional capacity in abdominal surgery. Studies have focused on exercise alone and have reported negative results. Protein supplementation combined with exercise may stimulate muscle gain and anxiety reduction may improve compliance and recovery. Methods: In this pre/post intervention study, functional walking capacity during prehabilitation and at 8 weeks after surgery was compared between 42 patients having completed the trimodal prehabilitation intervention and 45 previously assessed controls. Results: Functional walking capacity improved by an average 42 ± 41 meters during prehabilitation. At 8 weeks after surgery, patients undergoing prehabilitation were 64 meters above controls on multivariate analysis. 81% of prehabilitated patients were considered recovered versus 40% of controls. There was no difference in postoperative complication rates.Conclusion: A trimodal prehabilitation program improved both functional capacity preoperatively and postoperative functional recovery." --
Author: Tram Bui Ngoc
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Book Description
In patients with hepatobiliary and pancreatic cancers, surgery is the only potential curative treatment for resection candidates (Benson et al., 2009; Freelove & Walling, 2006). A five-year research experience in patients undergoing surgery for colorectal cancer found that prehabilitation led to faster return to preoperative walking capacity than rehabilitation (Minnella et al., 2017). There has been no studies thus far evaluating the impact of a trimodal prehabilitation program on functional recovery in patients undergoing hepatobiliary or pancreatic cancer surgery. Our goal was to determine the impact of prehabilitation on the functional exercise capacity of these patients. We performed a randomized controlled pilot trial comparing the impact of a prehabilitation program begun four weeks before surgery, to the same program (rehabilitation) initiated right after surgery. The program was maintained by both groups until eight weeks postoperatively. We hypothesized our prehabilitation program would improve 6-minute walk test performance preoperatively. Furthermore, at eight weeks post-surgery, we hypothesized greater 6-minute walk performance in the prehabilitation group compared to the rehabilitation group. Thirty-five participants were randomized to receive prehabilitation or rehabilitation. We found that preoperatively, the prehabilitation group demonstrated a clinically meaningful improvement in 6-minute walk distance. At four-weeks after surgery, the rehabilitation group experienced a statistically and clinically significant decrease in mean 6-minute walk distance from baseline, whereas the prehabilitation group was able to maintain its baseline walking capacity. Our findings suggest that a prehabilitation program in hepatobiliary and pancreatic cancer patients can deliver meaningful changes in pre- and postoperative functional exercise capacity.
