预康复干预对结直肠癌患者术后临床结局影响的meta分析

doi:10.3760/cma.j.issn.1007-1245.2024.03.004

国际医药卫生导报 ›› 2024, Vol. 30 ›› Issue (3): 367-373.DOI: 10.3760/cma.j.issn.1007-1245.2024.03.004

预康复干预对结直肠癌患者术后临床结局影响的meta分析

张凯思¹ 马金栋² 张启慧² 陈强谱^1,2

¹滨州医学院附属医院肝胆外科，滨州　256600；²滨州医学院附属医院临床营养科，滨州　256600

收稿日期:2023-09-22 出版日期:2024-02-01 发布日期:2024-03-06
通讯作者: 陈强谱，Email：drcqp@263.net
基金资助:
山东省胆胰肿瘤临床精品特色专科（SLCZDZK-2401）；山东省省级临床重点专科学科（SLCZDZK-0701）

Meta-analysis on impact of prehabilitation on clinical outcomes after surgery of patients with colorectal cancer

Zhang Kaisi¹, Ma Jindong², Zhang Qihui², Chen Qiangpu^1,2

¹Department of General Surgery, Binzhou Medical University Hospital, Binzhou 256600, China; ²Department of Clinical Nutrition, Binzhou Medical University Hospital, Binzhou 256600, China

Received:2023-09-22 Online:2024-02-01 Published:2024-03-06
Contact: Chen Qiangpu, Email: drcqp@263.net
Supported by:
Clinical High-quality Characteristic Specialty of Biliary and Pancreatic Tumors in Shandong Province (SLCZDZK-2401); Provincial Key Clinical Specialist Disciplines in Shandong Province (SLCZDZK-0701)

摘要/Abstract

摘要：

目的　探讨预康复对结直肠癌患者术后临床结局的影响。方法　检索PubMed、Embase、Cochrane Library、Web of Science数据库，检索时限从各数据库建库至2023年3月。收集预康复对结直肠癌手术患者影响的相关文献，由2名研究者对纳入文献独立进行质量评价。采用RevMan5.3软件对术后总并发症发生率，首次肛门排气时间，胃肠功能障碍、肺炎、术后吻合口瘘发生率，住院时间及病死率等指标进行分析。结果　纳入文献共13篇，总样本量为8 311例，其中预康复组3 033例，对照组5 278例。meta分析结果显示，预康复组术后总并发症发生率低于对照组（OR=0.55，95%CI 0.39～0.77，P<0.05），术后首次肛门排气时间短于对照组（WMD=-0.70，95%CI -1.29～-0.11，P<0.05），胃肠功能障碍发生率低于对照组（OR=0.53，95%CI 0.43～0.65，P<0.05）；两组患者术后肺炎和吻合口瘘发生率、住院时间及病死率差异均无统计学意义（均P>0.05）。结论　预康复可降低结直肠癌患者术后总并发症发生率，缩短术后首次肛门排气时间及减少胃肠功能障碍的发生，有助于改善患者临床结局。

关键词:

结直肠癌, 预康复, 结直肠外科, 术后并发症, meta分析

Abstract:

Objective　To explore the effect of prehabilitation on the clinical outcomes after surgery of patients with colorectal cancer. Methods　The PubMed, Embase, Cochrane Library, and Web of Science were searched to collect relevant literatures of the effects of prehabilitation for patients undergoing colorectal cancer surgery from their establishment to March, 2023. Two reviewers independently evaluated the quality of the included studies. The RevMan 5.3 software was used for the meta-analysis of the total incidence of postoperative complications, time to first anal exhaust, incidences of gastrointestinal dysfunction, pneumonia, and anastomotic leakage, hospital stay, and mortality. Results　A total of 13 articles with a sample size of 8 311 cases were enrolled, including 3 033 cases in the prehabilitation group and 5 278 cases in the control group. The meta-analysis results showed that the prehabilitation group had a lower incidence of postoperative complications (OR=0.55, 95%CI 0.39-0.77, P<0.05), shorter time to first anal exhaust (WMD=-0.70, 95%CI -1.29 to -0.11, P<0.05), and a lower incidence of gastrointestinal dysfunction (OR=0.53, 95%CI 0.43-0.65, P<0.05) than the control group. There were no statistical differences in the incidences of postoperative pneumonia and anastomotic leakage, hospital stay, and mortality between the two groups (all P>0.05). Conclusion　Prehabilitation can reduce the total incidence of postoperative complications in patients with colorectal cancer, shorten the time to first anal exhaust, decrease the incidence of gastrointestinal dysfunction, and improve their clinical outcomes.

Key words:

Colorectal cancer, Prehabilitation, Colorectal surgery, Postoperative complications, Meta-analysis

张凯思马金栋张启慧陈强谱.

预康复干预对结直肠癌患者术后临床结局影响的meta分析 [J]. 国际医药卫生导报, 2024, 30(3): 367-373.

Zhang Kaisi, Ma Jindong, Zhang Qihui, Chen Qiangpu.

Meta-analysis on impact of prehabilitation on clinical outcomes after surgery of patients with colorectal cancer [J]. International Medicine and Health Guidance News, 2024, 30(3): 367-373.

参考文献

[1] Topp R, Ditmyer M, King K, et al. The effect of bed rest and potential of prehabilitation on patients in the intensive care unit [J]. AACN Clin Issues, 2002, 13(2):263-276. DOI: 10.1097/00044067-200205000-00011.
[2] Minnella EM, Carli F. Prehabilitation and functional recovery for colorectal cancer patients [J]. Eur J Surg Oncol, 2018, 44(7): 919-926. DOI: 10.1016/j.ejso. 2018.04.016.
[3] Li C, Carli F, Lee L, et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study [J]. Surg Endosc, 2013, 27(4): 1072-1082. DOI: 10.1007/s00464-012- 2560-5.
[4] Hijazi Y, Gondal U, Aziz O. A systematic review of prehabilitation programs in abdominal cancer surgery [J]. Int J Surg, 2017, 39: 156-162. DOI: 10.1016/j.ijsu.2017.01.111.
[5] Carli F, Bousquet-Dion G, Awasthi R, et al. Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer: a randomized clinical trial [J]. JAMA Surg, 2020, 155(3): 233-242. DOI: 10.1001/jamasurg.2019.5474.
[6] Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample [J]. BMC Med Res Methodol, 2005, 5: 13. DOI: 10.1186/1471-2288-5-13.
[7] Berkel AEM, Bongers BC, Kotte H, et al. Effects of community-based exercise prehabilitation for patients scheduled for colorectal surgery with high risk for postoperative complications: results of a randomized clinical trial [J]. Ann Surg, 2022, 275(2): e299-e306. DOI: 10.1097/SLA.0000000000004702.
[8] Peng LH, Wang WJ, Chen J, et al. Implementation of the pre-operative rehabilitation recovery protocol and its effect on the quality of recovery after colorectal surgeries [J]. Chin Med J (Engl), 2021, 134(23):2865-2873. DOI: 10.1097/CM9.0000000000001709.
[9] van Rooijen SJ, Molenaar CJL, Schep G, et al. Making patients fit for surgery: introducing a four pillar multimodal prehabilitation program in colorectal cancer [J]. Am J Phys Med Rehabil, 2019, 98(10): 888-896. DOI: 10.1097/PHM.0000000000001221.
[10] López-Rodríguez-Arias F, Sánchez-Guillén L, Aranaz-Ostáriz V, et al. Effect of home-based prehabilitation in an enhanced recovery after surgery program for patients undergoing colorectal cancer surgery during the COVID-19 pandemic [J]. Support Care Cancer, 2021, 29(12): 7785-7791. DOI: 10.1007/s00520-021-06343-1.
[11] Gillis C, Li C, Lee L, et al. Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer [J]. Anesthesiology, 2014, 121(5): 937-947. DOI: 10.1097/ALN.0000000000000393.
[12] van der Hulst HC, Bastiaannet E, Portielje JEA, et al. Can physical prehabilitation prevent complications after colorectal cancer surgery in frail older patients? []. Eur J Surg Oncol, 2021, 47(11): 2830-2840. DOI: 10.1016/j.ejso.2021.05.044.
[13] Achilli P, Mazzola M, Bertoglio CL, et al. Preoperative immunonutrition in frail patients with colorectal cancer: an intervention to improve postoperative outcomes [J]. Int J Colorectal Dis, 2020, 35(1): 19-27. DOI: 10.1007/s00384-019-03438-4.
[14] Watanabe T, Momosaki R, Suzuki S, et al. Preoperative rehabilitation for patients undergoing colorectal cancer surgery: a retrospective cohort study [J]. Support Care Cancer, 2020, 28(5): 2293-2297. DOI: 10.1007/s00520-019-05061-z.
[15] van der Vlies E, Smits AB, Los M, et al. Implementation of a preoperative multidisciplinary team approach for frail colorectal cancer patients: influence on patient selection, prehabilitation and outcome [J]. J Geriatr Oncol, 2020, 11(8): 1237-1243. DOI: 10.1016/j.jgo.2020.04.011.
[16] de Klerk M, van Dalen DH, Nahar-van Venrooij LMW, et al. A multimodal prehabilitation program in high-risk patients undergoing elective resection for colorectal cancer: a retrospective cohort study [J]. Eur J Surg Oncol, 2021, 47(11): 2849-2856. DOI: 10.1016/j.ejso.2021.05.033.
[17] Fabulas F, Paisant P, Dinomais M, et al. Pre-habilitation before colorectal cancer surgery could improve postoperative gastrointestinal function recovery: a case-matched study [J]. Langenbecks Arch Surg, 2022, 407(4): 1595-1603. DOI: 10.1007/s00423-022-02487-8.
[18] Ushida K, Yamamoto Y, Hori S, et al. The effect of preoperative rehabilitation on the prevention of postoperative ileus in colorectal cancer patients [J]. Support Care Cancer, 2023, 31(2): 123. DOI: 10.1007/s00520-023-07585-x.
[19] Sharp SP, Malizia R, Skancke M, et al. A NSQIP analysis of trends in surgical outcomes for rectal cancer: What can we improve upon? [J]. Am J Surg, 2020, 220(2): 401-407. DOI: 10.1016/j.amjsurg.2020.01.004.
[20] GlobalSurg Collaborative and NIHR Global Health Unit on Global Surgery. Impact of malnutrition on early outcomes after cancer surgery: an international, multicentre, prospective cohort study [J]. Lancet Glob Health, 2023, 11(3): e341-e349. DOI: 10.1016/S2214-109X(22)00550-2.
[21] Molenaar CJL, Minnella EM, Coca-Martinez M, et al. Effect of multimodal prehabilitation on reducing postoperative complications and enhancing functional capacity following colorectal cancer surgery: the PREHAB randomized clinical trial [J]. JAMA Surg, 2023, 158(6): 572-581. DOI: 10.1001/jamasurg.2023.0198.
[22] Muscaritoli M, Arends J, Bachmann P, et al. ESPEN practical guideline: clinical nutrition in cancer [J]. Clin Nutr, 2021, 40(5): 2898-2913. DOI: 10.1016/j.clnu.2021.02.005.
[23] Gillis C, Buhler K, Bresee L, et al. Effects of nutritional prehabilitation, with and without exercise, on outcomes of patients who undergo colorectal surgery: a systematic review and meta-analysis [J]. Gastroenterology, 2018, 155(2):391-410.e4. DOI: 10.1053/j.gastro.2018.05.012.
[24] 周岩冰. 胃肠肿瘤患者的术前预康复[J]. 中华胃肠外科杂志,2021,24(2):122-127. DOI:10.3760/cma.j.cn.441530-20200318-00152.
[25] Falz R, Bischoff C, Thieme R, et al. Effects and duration of exercise-based prehabilitation in surgical therapy of colon and rectal cancer: a systematic review and meta-analysis [J]. J Cancer Res Clin Oncol, 2022, 148(9): 2187-2213. DOI: 10.1007/s00432-022-04088-w.
[26] Minnella EM, Ferreira V, Awasthi R, et al. Effect of two different pre-operative exercise training regimens before colorectal surgery on functional capacity: a randomised controlled trial [J]. Eur J Anaesthesiol, 2020, 37(11): 969-978. DOI: 10.1097/EJA.0000000000001215.
[27] Molenaar CJ, van Rooijen SJ, Fokkenrood HJ, et al. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery [J]. Cochrane Database Syst Rev, 2022, 5(5): CD013259. DOI: 10.1002/14651858.CD013259.pub2.
[28] Hughes MJ, Hackney RJ, Lamb PJ, et al. Prehabilitation before major abdominal surgery: a systematic review and meta-analysis [J]. World J Surg, 2019, 43(7):1661-1668. DOI: 10.1007/s00268-019-04950-y.

预康复干预对结直肠癌患者术后临床结局影响的meta分析

Meta-analysis on impact of prehabilitation on clinical outcomes after surgery of patients with colorectal cancer

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