改善即将接受手术的结直肠癌患者术后预后的康复训练的实际效果：观察性研究与随机对照试验的系统回顾和荟萃分析。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso Pub Date : 2024-09-28 DOI:10.1016/j.ejso.2024.108708

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引用次数: 0

摘要

简介：目前对结直肠手术术前康复研究的证据综述是基于随机对照试验（RCT）的结果。尽管随机对照试验是有效性研究的黄金标准，但观察性研究可能更能反映现实生活中的实践。本研究的目的是比较观察性研究和随机对照试验在术前康复与术后结果之间的关系，以及纳入的患者和干预措施的特点：方法：在 PubMed、Embase 和 CINAHL（截至 2023 年 9 月）上进行了系统检索。方法：在PubMed、Embed和CINAHL（截至2023年9月）上进行了系统性检索，纳入了调查结直肠手术前康复的观察性研究和RCT，并报告了术后并发症和/或住院时间（LoS）。两名审稿人使用 Cochrane Risk of Bias 2 工具独立评估了 RCT 的偏倚风险，并使用 Cochrane ROBINS-I 工具评估了观察性研究的偏倚风险。对术后并发症和LoS进行了元（回归）分析：汇总结果显示，在观察性研究中，术前康复后术后并发症（OR 0.54；95 % 置信区间（CI）0.40 至 0.72）和 LoS（平均差（MD）-1.34 CI -2.57 至 -0.12）显著减少，但在研究性试验中却没有显著减少（并发症 OR 0.95；CI 0.53 至 1.72；LoS MD 0.16 CI -0.52 至 0.83）。纳入观察性研究的患者年龄较大，ASA评分≥3分的患者较多。在一项荟萃回归分析中，这些特征与主要结果没有显著的统计学关联：结论：现实生活中的观察性研究表明，术前康复可减少术后并发症和LoS。为了进一步探索术前康复在现实生活中的有效性，可以采用特定的观察性研究设计，如目标模拟试验。

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Real-life effectiveness of prehabilitation to improve postoperative outcomes in patients with colorectal cancer approaching surgery: A systematic review and meta-analyses of observational studies versus randomized controlled trials

Introduction

Current evidence synthesis of prehabilitation studies in colorectal surgery is based on results of randomized controlled trials (RCT). Although RCTs are the gold standard for effectiveness research, observational studies probably better reflect real-life practice. The aims of the current study were to compare observational studies to RCTs regarding the association between prehabilitation and postoperative outcomes, and characteristics of included patients and interventions.

Methods

A systematic search was conducted in PubMed, Embase, and CINAHL (until September 2023). Observational studies and RCTs investigating prehabilitation before colorectal surgery and reporting postoperative complications and/or length of stay (LoS) were included. Two reviewers independently assessed the risk of bias using the Cochrane Risk of Bias 2 tool for RCTs and the Cochrane ROBINS-I tool for observational studies. Meta(regression)-analyses were performed for postoperative complications and LoS.

Results

Pooled results showed a statistically significant reduction in postoperative complications (OR 0.54; 95 % confidence interval (CI) 0.40 to 0.72) and LoS (mean difference (MD) −1.34 CI -2.57 to −0.12) after prehabilitation in observational studies but not in RCTs (complications OR 0.95; CI 0.53 to 1.72; LoS MD 0.16 CI -0.52 to 0.83). Patients included in observational studies were older and more often had an ASA score ≥3. In a meta-regression analysis, these characteristics were not statistically significantly associated with the main outcomes.

Conclusion

Observational studies in a real-life setting showed that prehabilitation can reduce postoperative complications and LoS. To further explore the real-life effectiveness of prehabilitation, specific observational study designs, like a target emulation trial could be used.

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来源期刊

Ejso 医学-外科

CiteScore

6.40

自引率

2.60%

发文量

1148

审稿时长

41 days

期刊介绍： JSO - European Journal of Surgical Oncology ("the Journal of Cancer Surgery") is the Official Journal of the European Society of Surgical Oncology and BASO ~ the Association for Cancer Surgery. The EJSO aims to advance surgical oncology research and practice through the publication of original research articles, review articles, editorials, debates and correspondence.