Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지
DOI QR코드

DOI QR Code

Outcomes of an outpatient home-based prehabilitation program before pancreaticoduodenectomy: A retrospective cohort study

  • Kai Siang Chan (Department of General Surgery, Tan Tock Seng Hospital) ;
  • Sameer Padmakumar Junnarkar (Department of General Surgery, Tan Tock Seng Hospital) ;
  • Bei Wang (Department of General Surgery, Tan Tock Seng Hospital) ;
  • Yen Pin Tan (Department of General Surgery, Tan Tock Seng Hospital) ;
  • Jee Keem Low (Department of General Surgery, Tan Tock Seng Hospital) ;
  • Cheong Wei Terence Huey (Department of General Surgery, Tan Tock Seng Hospital) ;
  • Vishalkumar Girishchandra Shelat (Department of General Surgery, Tan Tock Seng Hospital)
  • Received : 2022.05.16
  • Accepted : 2022.08.01
  • Published : 2022.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Backgrounds/Aims: Prehabilitation aims for preoperative optimisation to reduce postoperative complications. However, there is a paucity of data on its use in patients undergoing pancreaticoduodenectomy (PD). Thus, this study aims to evaluate the outcomes of a home-based outpatient prehabilitation program (PP) versus no-PP in patients undergoing PD. Methods: This retrospective cohort study compared patients who underwent PP versus no-PP before elective PD from January 2016 to December 2020. Inclusion criteria for PP were < 65 years or 65-74 years with FRAIL score < 3. No-PP included dietician, case manager and anesthesia review. PP included additional physiotherapy sessions, caregiver training and interim phone consultation. Univariate and multivariate analysis were used to evaluate length of stay (LOS), morbidity, 30-day readmission, and 90-day mortality. Results: Seventy-one patients (PP: n = 50 [70.4%]; no-PP: n = 21 [29.6%]) were included in this study. Median age was 65 years (interquartile range [IQR]: 58-72 years). Majority (n = 58 [81.7%]) of patients underwent open surgery. Ductal adenocarcinoma was the most common histology (49.3%). Patient demographics were comparable between both groups. Overall median LOS was 11.0 days (IQR: 8.0-17.0 days). Compared to no-PP, PP was not independently associated with reduced intra-abdominal collections (odds ratio [OR]: 0.43; 95% confidence interval [CI]: 0.03-6.11, p = 0.532), major morbidity (OR: 1.31; 95% CI: 0.09-19.47; p = 0.845) or 30-day readmission (OR: 3.16; 95% CI: 0.26-38.27; p = 0.365). There was one (1.4%) 30-day mortality. Conclusions: Our outpatient PP with unsupervised exercise regimes did not improve postoperative outcomes following elective PD.

Keywords

References

  1. McGuigan A, Kelly P, Turkington RC, Jones C, Coleman HG, McCain RS. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol 2018;24:4846-4861.
  2. Allen PJ, Kuk D, Castillo CF, Basturk O, Wolfgang CL, Cameron JL, et al. Multi-institutional validation study of the American Joint Commission on Cancer (8th Edition) changes for T and N staging in patients with pancreatic adenocarcinoma. Ann Surg 2017;265:185-191.
  3. Gong Y, Zhang L, He T, Ding J, Zhang H, Chen G, et al. Pancreaticoduodenectomy combined with vascular resection and reconstruction for patients with locally advanced pancreatic cancer: a multicenter, retrospective analysis. PLoS One 2013;8:e70340.
  4. Chakravarty KD, Hsu JT, Liu KH, Yeh CN, Yeh TS, Hwang TL, et al. Prognosis and feasibility of en-bloc vascular resection in stage II pancreatic adenocarcinoma. World J Gastroenterol 2010;16:997-1002.
  5. Bundred J, Kamarajah SK, Roberts KJ. Body composition assessment and sarcopenia in patients with pancreatic cancer: a systematic review and meta-analysis. HPB (Oxford) 2019;21:1603-1612.
  6. Cooper AB, Slack R, Fogelman D, Holmes HM, Petzel M, Parker N, et al. Characterization of anthropometric changes that occur during neoadjuvant therapy for potentially resectable pancreatic cancer. Ann Surg Oncol 2015;22:2416-2423.
  7. Joglekar S, Asghar A, Mott SL, Johnson BE, Button AM, Clark E, et al. Sarcopenia is an independent predictor of complications following pancreatectomy for adenocarcinoma. J Surg Oncol 2015;111:771-775.
  8. Fearon KC, Ljungqvist O, Von Meyenfeldt M, Revhaug A, Dejong CH, Lassen K, et al. Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection. Clin Nutr 2005;24:466-477.
  9. Strasser B, Steindorf K, Wiskemann J, Ulrich CM. Impact of resistance training in cancer survivors: a meta-analysis. Med Sci Sports Exerc 2013;45:2080-2090.
  10. Nakajima H, Yokoyama Y, Inoue T, Nagaya M, Mizuno Y, Kadono I, et al. Clinical benefit of preoperative exercise and nutritional therapy for patients undergoing hepato-pancreato-biliary surgeries for malignancy. Ann Surg Oncol 2019;26:264-272.
  11. Ausania F, Senra P, Melendez R, Caballeiro R, Ouvina R, CasalNunez E. Prehabilitation in patients undergoing pancreaticoduodenectomy: a randomized controlled trial. Rev Esp Enferm Dig 2019;111:603-608.
  12. Bundred JR, Kamarajah SK, Hammond JS, Wilson CH, Prentis J, Pandanaboyana S. Prehabilitation prior to surgery for pancreatic cancer: a systematic review. Pancreatology 2020;20:1243-1250.
  13. Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging 2012;16:601-608.
  14. Mohan R, Huey CWT, Junnarkar S, Low JK, Shelat VG. Prehabilitation in elderly patients scheduled for liver resection and protocol for recovery of surgery in elderly. Hepatoma Res 2020;6:13.
  15. Von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007;147:573-577. Erratum in: Ann Intern Med 2008;148:168.
  16. Gianotti L, Braga M, Gentilini O, Balzano G, Zerbi A, Di Carlo V. Artificial nutrition after pancreaticoduodenectomy. Pancreas 2000;21:344-351.
  17. Yang C, Wu HS, Chen XL, Wang CY, Gou SM, Xiao J, et al. Pylorus-preserving versus pylorus-resecting pancreaticoduodenectomy for periampullary and pancreatic carcinoma: a meta-analysis. PLoS One 2014;9:e90316.
  18. Ferguson B. ACSM's guidelines for exercise testing and prescription 9th Ed. 2014. J Can Chiropr Assoc 2014;58:328.
  19. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250:187-196.
  20. Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery 2017;161:584-591.
  21. Dagorno C, Sommacale D, Laurent A, Attias A, Mongardon N, Levesque E, et al. Prehabilitation in hepato-pancreato-biliary surgery: a systematic review and meta-analysis. A necessary step forward evidence-based sample size calculation for future trials. J Visc Surg 2022;159:362-372.
  22. Braga M, Capretti G, Pecorelli N, Balzano G, Doglioni C, Ariotti R, et al. A prognostic score to predict major complications after pancreaticoduodenectomy. Ann Surg 2011;254:702-707; discussion 707-708.
  23. Venkat R, Puhan MA, Schulick RD, Cameron JL, Eckhauser FE, Choti MA, et al. Predicting the risk of perioperative mortality in patients undergoing pancreaticoduodenectomy: a novel scoring system. Arch Surg 2011;146:1277-1284.
  24. Bentrem DJ, Yeh JJ, Brennan MF, Kiran R, Pastores SM, Halpern NA, et al. Predictors of intensive care unit admission and related outcome for patients after pancreaticoduodenectomy. J Gastrointest Surg 2005;9:1307-1312.
  25. Hughes MJ, Hackney RJ, Lamb PJ, Wigmore SJ, Christopher Deans DA, Skipworth RJE. Prehabilitation before major abdominal surgery: a systematic review and meta-analysis. World J Surg 2019;43:1661-1668.
  26. Wang B, Shelat VG, Chow JJL, Huey TCW, Low JK, Woon WWL, et al. Prehabilitation program improves outcomes of patients undergoing elective liver resection. J Surg Res 2020;251:119-125.
  27. Nickel F, Haney CM, Kowalewski KF, Probst P, Limen EF, Kalkum E, et al. Laparoscopic versus open pancreaticoduodenectomy: a systematic review and meta-analysis of randomized controlled trials. Ann Surg 2020;271:54-66.
  28. Paiella S, De Pastena M, Pollini T, Zancan G, Ciprani D, De Marchi G, et al. Pancreaticoduodenectomy in patients ≥ 75 years of age: are there any differences with other age ranges in oncological and surgical outcomes? Results from a tertiary referral center. World J Gastroenterol 2017;23:3077-3083.
  29. Yuan F, Essaji Y, Belley-Cote EP, Gafni A, Latchupatula L, Ruo L, et al. Postoperative complications in elderly patients following pancreaticoduodenectomy lead to increased postoperative mortality and costs. A retrospective cohort study. Int J Surg 2018;60:204-209.
  30. Driessen EJ, Peeters ME, Bongers BC, Maas HA, Bootsma GP, van Meeteren NL, et al. Effects of prehabilitation and rehabilitation including a home-based component on physical fitness, adherence, treatment tolerance, and recovery in patients with non-small cell lung cancer: a systematic review. Crit Rev Oncol Hematol 2017;114:63-76.
  31. Cheville AL, Kollasch J, Vandenberg J, Shen T, Grothey A, Gamble G, et al. A home-based exercise program to improve function, fatigue, and sleep quality in patients with Stage IV lung and colorectal cancer: a randomized controlled trial. J Pain Symptom Manage 2013;45:811-821.
  32. Coats V, Maltais F, Simard S, Frechette E, Tremblay L, Ribeiro F, et al. Feasibility and effectiveness of a home-based exercise training program before lung resection surgery. Can Respir J 2013;20:e10-e6.
  33. Hoffman AJ, Brintnall RA, von Eye A, Jones LW, Alderink G, Patzelt LH, et al. A rehabilitation program for lung cancer patients during postthoracotomy chemotherapy. Onco Targets Ther 2014;7:415-423.
  34. Witlox L, Velthuis MJ, Boer JH, Steins Bisschop CN, Wall EV, Meulen WJTMV, et al. Attendance and compliance with an exercise program during localized breast cancer treatment in a randomized controlled trial: the PACT study. PLoS One 2019;14:e0215517.
  35. Dunne DF, Jack S, Jones RP, Jones L, Lythgoe DT, Malik HZ, et al. Randomized clinical trial of prehabilitation before planned liver resection. Br J Surg 2016;103:504-512.
  36. Kaibori M, Matsui K, Yoshii K, Ishizaki M, Iwasaka J, Miyauchi T, et al. Perioperative exercise capacity in chronic liver injury patients with hepatocellular carcinoma undergoing hepatectomy. PLoS One 2019;14:e0221079.
  37. Chan KS, Chia CLK, Ng FKL, Seow WHJ, Leong DY, Shelat VG. Impaired handgrip strength does not predict postoperative morbidity in major hepatobiliary surgery. J Surg Res 2020;256:549-556.