Home-Based Trimodal Prehabilitation in Patients with Peritoneal Carcinomatosis Undergoing Cytoreductive Surgery: Effect on Functional Walking Capacity and Skeletal Muscle Mass.

Autor: Lario-Perez S; Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain., Macia JJ; Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain., Lillo-Garcia C; Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain., Caravaca I; Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain., Lopez-Rodriguez F; Colorectal Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain.; Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain., Calero A; Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain.; Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain., Tomas-Rodriguez MI; Center for Translational Research in Physiotherapy, Pathology and Surgery Department, Miguel Hernandez University of Elche, Elche, Spain.; Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain., Moya-Martinez A; Statistical Department, FISABIO, University General Hospital of Elche, Elche, Spain., Arroyo A; Colorectal Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain.; Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain., Lacueva FJ; Oncological Abdominal and Pelvic Surgery Unit, General Surgery Department, University General Hospital of Elche, Elche, Spain. fj.lacueva@umh.es.; Department of Pathology and Surgery, Miguel Hernández University, San Juan de Alicante, Alicante, Spain. fj.lacueva@umh.es.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Oct; Vol. 31 (10), pp. 7133-7141. Date of Electronic Publication: 2024 Jul 16.
DOI: 10.1245/s10434-024-15756-1
Abstrakt: Background: Patients with peritoneal carcinomatosis often suffer from loss of skeletal muscle mass and require extensive surgery. Multimodal prehabilitation may improve physical status but its benefits for these specific patients remain unknown. This study aimed to evaluate the effect of prehabilitation on functional walking capacity and skeletal muscle mass, as well as its association with postoperative complications.
Patients and Methods: A prospective study of patients with peritoneal carcinomatosis following a home-based trimodal prehabilitation program was carried out. Functional walking capacity was assessed with the 6-min walk test (T6MWT), and by the appendicular skeletal muscle index (ASMI) estimated by bioelectrical impedance analysis. Data were collected at the first medical appointment and on the day before surgery. A 90-day postoperative morbidity was registered according to the Clavien-Dindo classification.
Results: A total of 62 patients were included in the analysis. Women were more prevalent (77.4%) and peritoneal metastasis from ovarian origin accounted for 48.4%. Clavien II-V grades occurred in 30 (57.7%) patients. After prehabilitation, functional walking capacity improved by 42.2 m (39.62-44.72 m) compared with baseline data (p < 0.001), but no improvement was observed in the ASMI (p = 0.301). Patients able to walk at least 360 m after prehabilitation suffered fewer Clavien-Dindo II-V postoperative complications (p = 0.016). A T6MWT of less than 360 m was identified as an independent risk factor in the multivariable analysis (OR 3.99; 1.01-15.79 p = 0.048).
Conclusions: This home-based trimodal prehabilitation program improved functional walking capacity but not ASMI scores in patients with peritoneal metastasis before surgery. A T6MWT of less than 360 m was found to be a risk factor for postoperative complications.
(© 2024. Society of Surgical Oncology.)
Databáze: MEDLINE
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