D Pfirrmann1, P Simon1, M Mehdorn2, M Hänsig2, S Stehr3, L Selig4, A Weimann5, M Knödler6, F Lordick6, A Mehnert7, I Gockel8. 1. Abteilung Sportmedizin, Prävention und Rehabilitation am Institut für Sportwissenschaft, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland. 2. Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax‑ und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland. 3. Klinik und Poliklinik für Anästhesiologie und Intensivmedizin (KAI), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland. 4. Klinik und Poliklinik für Gastroenterologie und Rheumatologie; Ernährungsteam, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland. 5. Klinik und Poliklinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Leipzig, Deutschland. 6. Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland. 7. Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland. 8. Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax‑ und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland. ines.gockel@medizin.uni-leipzig.de.
Abstract
BACKGROUND: Postoperative complications after complex visceral oncological surgery can lead to substantial impairment of patients. In addition, preoperative physical performance and the severity of postoperative complications determine the long-term recovery process of physical function. Therefore, preconditioning in the preoperative period should be an important part of the preoperative/neoadjuvant treatment. OBJECTIVE: The aim of this article is a critical appraisal of current concepts of prehabilitation as well as their development potential and applicability in visceral surgery. MATERIAL AND METHODS: Based on a selective literature review, current studies and implemented concepts are presented and therapy algorithms are provided. RESULTS: This study differs in primary outcome, design and temporal framework of the intervention. The study results showed positive effects of an active increase in physical fitness in the preoperative period with respect to the quality of life, convalescence and postoperative pulmonary complication rate. DISCUSSION: In addition to the assessment of the individual risk of complications by means of spiroergometry, a targeted nutrition and exercise program can increase the individual performance level prior to visceral surgery and, thus, influence the postoperative risk of complications. The performance should be understood as a modifiable risk factor, which can also be positively influenced in the preoperative phase, even in a short time period. Individual preoperative care optimizes the physical and psychological situation of patients. To ensure the required individual care, approaches must be created and pursued, which can be implemented in a decentralized way.
BACKGROUND: Postoperative complications after complex visceral oncological surgery can lead to substantial impairment of patients. In addition, preoperative physical performance and the severity of postoperative complications determine the long-term recovery process of physical function. Therefore, preconditioning in the preoperative period should be an important part of the preoperative/neoadjuvant treatment. OBJECTIVE: The aim of this article is a critical appraisal of current concepts of prehabilitation as well as their development potential and applicability in visceral surgery. MATERIAL AND METHODS: Based on a selective literature review, current studies and implemented concepts are presented and therapy algorithms are provided. RESULTS: This study differs in primary outcome, design and temporal framework of the intervention. The study results showed positive effects of an active increase in physical fitness in the preoperative period with respect to the quality of life, convalescence and postoperative pulmonary complication rate. DISCUSSION: In addition to the assessment of the individual risk of complications by means of spiroergometry, a targeted nutrition and exercise program can increase the individual performance level prior to visceral surgery and, thus, influence the postoperative risk of complications. The performance should be understood as a modifiable risk factor, which can also be positively influenced in the preoperative phase, even in a short time period. Individual preoperative care optimizes the physical and psychological situation of patients. To ensure the required individual care, approaches must be created and pursued, which can be implemented in a decentralized way.
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