Prehabilitation prior to surgery for pancreatic cancer: A systematic review

James R Bundred; Sivesh K Kamarajah; John S Hammond; Colin H Wilson; James Prentis; Sanjay Pandanaboyana

doi:10.1016/j.pan.2020.07.411

Prehabilitation prior to surgery for pancreatic cancer: A systematic review

Pancreatology. 2020 Sep;20(6):1243-1250. doi: 10.1016/j.pan.2020.07.411. Epub 2020 Aug 3.

Authors

James R Bundred¹, Sivesh K Kamarajah², John S Hammond³, Colin H Wilson³, James Prentis⁴, Sanjay Pandanaboyana⁵

Affiliations

¹ College of Medical and Dental Sciences, University of Leeds, UK.
² Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle, UK; Institute of Cellular Medicine, Newcastle University, Newcastle, UK.
³ Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle, UK.
⁴ Department of Perioperative and Critical Care Medicine, Freeman Hospital, Newcastle, UK.
⁵ Department of Hepatobiliary, Pancreatic and Transplant Surgery, Freeman Hospital, Newcastle, UK; Population Health Sciences Institute, Newcastle University, Newcastle, UK. Electronic address: s.pandanaboyana@nhs.net.

PMID: 32826168
DOI: 10.1016/j.pan.2020.07.411

Abstract

Introduction: Prehabilitation aims to improve fitness and outcomes of patients undergoing major surgery. This systematic review aimed to appraise current available evidence regarding the role of prehabilitation in patients undergoing oncological pancreatic resection.

Methods: A systematic literature search of PUBMED, MEDLINE, EMBASE databases identified articles describing prehabilitation programmes before pancreatic resection for malignancy. Data collected included timing of prehabilitation, programme type, duration, adherence and post-operative outcome reporting.

Results: Six studies, including 193 patients were included in the final analysis. Three studies included patients undergoing neoadjuvant therapy followed by resection and 3 studies included patients undergoing upfront resection. Time from diagnosis to surgery ranged between 2 and 22 weeks across all studies. Two studies reported a professionally supervised exercise programme, and four described unsupervised programmes. Exercise programmes varied from 5 days to 6 months in duration. Adherence to exercise programmes was better with supervised programmes (99% reaching weekly activity goal vs 85%) and patients not undergoing neoadjuvant therapy (90% reaching weekly activity goal vs 82%). All studies reported improvement in muscle mass or markers of muscle function following prehabilitation. Two studies reported the impact of Prehabilitation on postoperative outcomes and Prehabilitation was associated with lower delayed gastric emptying and a shorter hospital stay with no impact on other postoperative outcomes.

Conclusion: Early evidence demonstrates that Prehabilitation programmes may improve postoperative outcomes following pancreatic surgery. However current Prehabilitaton programmes for patients undergoing pancreatic resection report diverse exercise regimens with no consensus regarding timing or length of Prehabilitation, warranting a need for standardisation of Prehabilitation programmes in pancreatic surgery.

Keywords: Pancreatic cancer; Pancreatic resection; Pancreaticoduodenectomy; Prehabilitation.

Publication types

Systematic Review

MeSH terms

Combined Modality Therapy
Digestive System Surgical Procedures
Exercise
Humans
Pancreatectomy / methods*
Pancreatic Neoplasms / surgery*
Pancreaticoduodenectomy / methods*
Postoperative Complications / epidemiology
Preoperative Exercise*
Treatment Outcome