Individual multimodal prehabilitation in high-risk patients undergoing major abdominal surgery following neoadjuvant treatment - a feasibility study.

Abstract

Purpose: Despite advancements in medicine, perioperative complications and functional decline remain challenges for patients undergoing major abdominal surgery, particularly in high-risk individuals with limited functional capacity and impaired nutritional status. Prehabilitation, which involves interventions before surgery, shows promise in addressing these issues, but the heterogeneity of studies limits specific recommendations. The integration of prehabilitation into clinical practice with special regard to the setting and modalities of treatment also remain unclear.

Methods: As a feasibility study for home-based prehabilitation high-risk patients (age ≥ 70 years, ASA ≥ 3) undergoing neoadjuvant treatment for non-metastatic esophageal, gastric, or rectal cancer, followed by oncological resection were included. A six-week multimodal supervised home-based prehabilitation program, including nutritional therapy, exercise, and psychological support, was implemented after neoadjuvant treatment and before surgery. Functional, nutritional, and quality of life (QoL) assessments were conducted at multiple points. Feasibility and adherence were assessed. Secondary explorative outcome measures included complication rates, hospital stay, readmission, and mortality, which were compared to a matched cohort.

Results: Of 24 enrolled patients, 20 completed the program, with high adherence to home-based workouts (91.8%), respiratory exercises (92.9%), and oral nutritional supplements (ONS) (88.7%). Functional and nutritional improvements were observed, including improved sit-to-stand performance (p = 0.025) and serum albumin levels (p = 0.001). QoL improved in the physical function domain (p = 0.009). Postoperative outcomes were similar between groups.

Conclusion: A supervised home-based prehabilitation program is feasible for high-risk patients, with high adherence to interventions and potential benefits in functional and nutritional status. Further research is needed to optimize program content, identify optimal patient populations, and assess long-term outcomes.