Role of Prehabilitation Following Major Uro-oncologic Surgery: a Narrative Review

Overview

Journal World J Urol

Specialty Urology

Date 2020 Oct 31

PMID 33128596

Citations 9

Authors

Enrico Maria Minnella

Francesco Carli

Wassim Kassouf

Affiliations

Soon will be listed here.

Abstract

Purpose: Functional status and physical independence play a key role in terms of quality of life, access to treatment, and continuity of care. Surgery, a central component of cancer treatments, leads to detrimental effects on functional capacity, which can be peculiarly relevant in vulnerable patients undergoing major procedures. Prehabilitation is a multidisciplinary intervention that uses the preoperative period to prevent or attenuate treatment-related functional decline and its subsequent consequences. This paper narratively reviews the rationale and the evidence of prehabilitation for uro-oncologic surgery.

Methods: A narrative review was conducted in August 2020, aiming to: (1) identify and discuss the impact of modifiable determinants of postoperative outcomes in urology and (2) review randomized controlled trials (RCT) exploring the role of preoperative exercise, nutrition, and psychological interventions in uro-oncologic surgery.

Results: Eight RCTs on preoperative conditioning interventions met the inclusion criteria, focusing on radical cystectomy for bladder cancer (RC) and radical prostatectomy for prostate cancer (RP). There is strong evidence that poor physical, nutritional and psychosocial status negatively impacts on surgical outcomes. Single modality interventions, such as preoperative exercise or nutrition alone, had no effect on 'traditional' surgical outcomes as length of stay or complication. However, multimodal approaches targeting postoperative functional status have shown to be effective and safe.

Conclusion: There is initial evidence on the effectiveness and safety of multimodal prehabilitation in preserving functional capacity following RC and RP. However, to date, outcomes such as complications and length of stay seem to be not affected by prehabilitation.

Citing Articles

Personalized Mobile App-Based Program for Preparation and Recovery After Radical Prostatectomy: Initial Evidence for Improved Outcomes From a Prospective Nonrandomized Study.

Martini A, Kesch C, Touzani A, Calleris G, Buhas B, Abou-Zahr R J Med Internet Res. 2024; 26:e55429.

PMID: 39671590 PMC: 11681284. DOI: 10.2196/55429.

Detailed description of multidisciplinary prehabilitation in patients admitted to nerve sparring radical prostatectomy - A randomized feasibility study protocol.

Pedersen M, Saxton J, Villumsen B, Jensen J, Birch S Contemp Clin Trials Commun. 2024; 40:101319.

PMID: 38947984 PMC: 11211855. DOI: 10.1016/j.conctc.2024.101319.

[Prehabilitation prior to radical prostatectomy : A useful concept?].

Butea-Bocu M, Beyer B, Muller G Urologie. 2023; 62(10):1041-1047.

PMID: 37620505 DOI: 10.1007/s00120-023-02173-7.

[Exercise therapy in prehabilitation : Current findings in urology].

Mendes Wefelnberg M, Reimer N, Baumann F Urologie. 2023; 62(10):1011-1016.

PMID: 37606656 DOI: 10.1007/s00120-023-02171-9.

Comment on "Role of prehabilitation following major uro‑oncologic surgery: a narrative review".

Beilstein C, Wuethrich P, Furrer M, Engel D World J Urol. 2022; 40(11):2825-2826.

PMID: 36048233 DOI: 10.1007/s00345-022-04140-x.

References

Gandaglia G, Varda B, Sood A, Pucheril D, Konijeti R, Sammon J . Short-term perioperative outcomes of patients treated with radical cystectomy for bladder cancer included in the National Surgical Quality Improvement Program (NSQIP) database. Can Urol Assoc J. 2014; 8(9-10):E681-7. PMC: 4216299. DOI: 10.5489/cuaj.2069. View

Trama A, Foschi R, Larranaga N, Sant M, Fuentes-Raspall R, Serraino D . Survival of male genital cancers (prostate, testis and penis) in Europe 1999-2007: Results from the EUROCARE-5 study. Eur J Cancer. 2015; 51(15):2206-2216. DOI: 10.1016/j.ejca.2015.07.027. View

Siegel R, Miller K, Jemal A . Cancer statistics, 2016. CA Cancer J Clin. 2016; 66(1):7-30. DOI: 10.3322/caac.21332. View

Geraerts I, van Poppel H, Devoogdt N, Laenen A, De Groef A, Van Kampen M . Progression and predictors of physical activity levels after radical prostatectomy. BJU Int. 2013; 114(2):185-92. DOI: 10.1111/bju.12465. View

Sanda M, Dunn R, Michalski J, Sandler H, Northouse L, Hembroff L . Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008; 358(12):1250-61. DOI: 10.1056/NEJMoa074311. View

Minnella E, Carli F . Prehabilitation and functional recovery for colorectal cancer patients. Eur J Surg Oncol. 2018; 44(7):919-926. DOI: 10.1016/j.ejso.2018.04.016. View

Pang K, Groves R, Venugopal S, Noon A, Catto J . Prospective Implementation of Enhanced Recovery After Surgery Protocols to Radical Cystectomy. Eur Urol. 2017; 73(3):363-371. DOI: 10.1016/j.eururo.2017.07.031. View

Carli F . Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response. Can J Anaesth. 2014; 62(2):110-9. DOI: 10.1007/s12630-014-0264-0. View

Khuri S, Henderson W, DePalma R, Mosca C, Healey N, Kumbhani D . Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005; 242(3):326-41. PMC: 1357741. DOI: 10.1097/01.sla.0000179621.33268.83. View

10.

Older P, Smith R . Experience with the preoperative invasive measurement of haemodynamic, respiratory and renal function in 100 elderly patients scheduled for major abdominal surgery. Anaesth Intensive Care. 1988; 16(4):389-95. DOI: 10.1177/0310057X8801600402. View

11.

Abdelmalak B, Cata J, Bonilla A, You J, Kopyeva T, Vogel J . Intraoperative tissue oxygenation and postoperative outcomes after major non-cardiac surgery: an observational study. Br J Anaesth. 2012; 110(2):241-9. DOI: 10.1093/bja/aes378. View

12.

Lorentz C, Gilbert K, Alemozaffar M, Patil D, Filson C . Risk of Readmission After Uncomplicated Hospitalization After Radical Cystectomy. Clin Genitourin Cancer. 2018; 16(4):e705-e710. DOI: 10.1016/j.clgc.2018.01.004. View

13.

Roghmann F, Trinh Q, Braun K, von Bodman C, Brock M, Noldus J . Standardized assessment of complications in a contemporary series of European patients undergoing radical cystectomy. Int J Urol. 2013; 21(2):143-9. DOI: 10.1111/iju.12232. View

14.

Hollenbeck B, Miller D, Taub D, Dunn R, Khuri S, Henderson W . The effects of adjusting for case mix on mortality and length of stay following radical cystectomy. J Urol. 2006; 176(4 Pt 1):1363-8. DOI: 10.1016/j.juro.2006.06.015. View

15.

Bazargani S, Ghodoussipour S, Tse B, Miranda G, Cai J, Schuckman A . The association between intraoperative fluid intake and postoperative complications in patients undergoing radical cystectomy with an enhanced recovery protocol. World J Urol. 2018; 36(3):401-407. DOI: 10.1007/s00345-017-2164-8. View

16.

Eisenberg M, Boorjian S, Cheville J, Thompson R, Thapa P, Kaushik D . The SPARC score: a multifactorial outcome prediction model for patients undergoing radical cystectomy for bladder cancer. J Urol. 2013; 190(6):2005-10. DOI: 10.1016/j.juro.2013.06.022. View

17.

Wei X, Lu J, Siddiqui K, Li F, Zhuang Q, Yang W . Does previous abdominal surgery adversely affect perioperative and oncologic outcomes of laparoscopic radical cystectomy?. World J Surg Oncol. 2018; 16(1):10. PMC: 5773160. DOI: 10.1186/s12957-018-1317-6. View

18.

Eswara J, Efstathiou J, Heney N, Paly J, Kaufman D, McDougal W . Complications and long-term results of salvage cystectomy after failed bladder sparing therapy for muscle invasive bladder cancer. J Urol. 2011; 187(2):463-8. DOI: 10.1016/j.juro.2011.09.159. View

19.

Mcdonald M, Liss M, Nseyo U, Gal D, Kane C, Kader A . Weight Loss Following Radical Cystectomy for Bladder Cancer: Characterization and Effect on Survival. Clin Genitourin Cancer. 2016; 15(1):86-92. DOI: 10.1016/j.clgc.2016.06.009. View

20.

Mathur S, Plank L, Hill A, Rice M, Hill G . Changes in body composition, muscle function and energy expenditure after radical cystectomy. BJU Int. 2007; 101(8):973-7. DOI: 10.1111/j.1464-410X.2007.07337.x. View