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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2019

01-01-2019 | Hepatobiliary Tumors

Clinical Benefit of Preoperative Exercise and Nutritional Therapy for Patients Undergoing Hepato-Pancreato-Biliary Surgeries for Malignancy

Authors: Hiroki Nakajima, PT, Yukihiro Yokoyama, MD, Takayuki Inoue, PT, PhD, Motoki Nagaya, PT, MSc, Yota Mizuno, PT, Izumi Kadono, MD, Kimitoshi Nishiwaki, MD, Yoshihiro Nishida, MD, Masato Nagino, MD

Published in: Annals of Surgical Oncology | Issue 1/2019

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Abstract

Background

The impact of prehabilitation on physical fitness and postoperative course after hepato-pancreato-biliary (HPB) surgeries for malignancy is unknown. The current study aimed to investigate the effect of preoperative exercise and nutritional therapies on nutritional status, physical fitness, and postoperative outcomes of patients undergoing an invasive HPB surgery for malignancy.

Methods

Patients who underwent open abdominal surgeries for HPB malignancies (major hepatectomy, pancreatoduodenectomy, or hepato-pancreatoduodenectomy) between 2016 and 2017 were subjected to prehabilitation. Patients before the introduction of prehabilitation were included as historical control subjects for 1:1 propensity score-matching (no-prehabilitation group). The preoperative nutritional status and postoperative course were compared between the two groups.

Results

The prehabilitation group consisted of 76 patients scheduled to undergo HPB surgeries for malignancy. An identical number of patients were selected as the no-prehabilitation group after propensity score-matching. During the waiting period, serum albumin levels were significantly deteriorated in the no-prehabilitation group, whereas this index did not deteriorate or even improved in the prehabilitation group. By performing prehabilitation, a 6-min walk distance and total muscle/fat ratio were significantly increased during the waiting period. Although the overall incidence of postoperative complications did not differ between the two groups, the postoperative hospital stay was shorter in the prehabilitation group than in the no-prehabilitation group (median, 23 vs 30 days; p = 0.045).

Conclusion

The introduction of prehabilitation prevented nutritional deterioration, improved physical fitness before surgery, and shortened the postoperative hospital stay for the patients undergoing HPB surgeries for malignancy.
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Metadata
Title
Clinical Benefit of Preoperative Exercise and Nutritional Therapy for Patients Undergoing Hepato-Pancreato-Biliary Surgeries for Malignancy
Authors
Hiroki Nakajima, PT
Yukihiro Yokoyama, MD
Takayuki Inoue, PT, PhD
Motoki Nagaya, PT, MSc
Yota Mizuno, PT
Izumi Kadono, MD
Kimitoshi Nishiwaki, MD
Yoshihiro Nishida, MD
Masato Nagino, MD
Publication date
01-01-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 1/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6943-2

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