PRÉ-HABILITAÇÃO E PROGNÓSTICO PÓS-OPERATÓRIO EM DOENTES ONCOLÓGICOS DE ALTO RISCO: UMA REVISÃO SISTEMÁTICA E META-ANÁLISE

  • Fábio Teixeira-Oliveira Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
  • Gleison Silva Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
  • Fátima Santos Experimental Pathology and Therapeutics Group, Portuguese Oncology Institute of Porto FG, EPE (IPO-Porto), Porto, Portugal http://orcid.org/0000-0003-3796-2054
  • Pedro C. Martins Experimental Pathology and Therapeutics Group, Portuguese Oncology Institute of Porto FG, EPE (IPO-Porto), Porto, Portugal http://orcid.org/0000-0002-1828-078X
  • Daniel Moreira-Gonçalves Research Center in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal; Experimental Pathology and Therapeutics Group, Portuguese Oncology Institute of Porto FG, EPE (IPO-Porto), Porto, Portugal http://orcid.org/0000-0002-7404-7405

Resumo




Introdução: A pré-habilitação visa otimizar os doentes antes do tratamento cirúrgico, com o objetivo de melhorar a sua recuperação pós-cirúrgica. Embora a eficácia desta intervenção para melhorar os principais desfechos clínicos pós-operatórios tenha sido reconhecida para a população cirúrgica de baixo risco, ainda não está claro até que ponto estes benefícios serão extensíveis também para doentes considerados de alto risco. Esta meta-análise avaliou o impacto da pré-habilitação em desfechos pós-operatórios de doentes oncológicos cirúrgicos de alto risco.


Metodologia: Procuramos estudos experimentais (randomizados e não randomizados) e observacionais que avaliaram o impacto da pré-habilitação na frequência e / ou gravidade (major e minor) das complicações pós-cirúrgicas (desfecho primário), tipo de complicações, capacidade funcional, readmissões hospitalares, tempo de hospitalização e mortalidade pós-cirúrgica até 30 dias (desfechos secundários). Doentes de alto risco para eventos cirúrgicos adversos foram definidos como frágeis e / ou com idade ≥70 anos e / ou com score ASA> III.


Resultados: foram encontrados 136 artigos, dos quais apenas 6 foram elegíveis para avaliação qualitativa e quantitativa (3 estudos randomizados e 3 estudos observacionais). A análise global incluiu um total de 674 participantes, com idade média de 78 anos, a maioria do sexo masculino. A pré-habilitação reduziu o risco de complicações major (diferença do risco –0,09, IC 95%: –0,15, – 0,03, p = 0,005; i2 = 27%, p = 0,24) e de complicações cirúrgicas (RR 0,62, IC 95% 0,43 a 0,89, p = 0,01; I2 = 33%, p = 0,22) em comparação com doentes que receberam o tratamento habitual. Além disso, a pré-habilitação reduziu o tempo de hospitalização (diferença média de – 2,7, IC 95%: –5,37 a –0,17, p = 0,04) e melhorou a recuperação funcional avaliada pela distância percorrida no teste de marcha de 6 minutos (diferença média de 29,06 metros, IC de 95% 26,55 a 31,57, I2 = 42%, p <0,001). Não foram observadas diferenças para as complicações gerais, complicações médicas, mortalidade pós-operatória até 30 dias ou na readmissão hospitalar.


Conclusão: O nosso trabalho sugere que a pré-habilitação é eficaz na melhoria do prognóstico pós-operatório de doentes oncológicos considerados de “alto risco” para complicações cirúrgicas. Ficou evidente a necessidade de desenvolver ensaios clínicos randomizados especialmente focados em doentes cirúrgicos de alto risco, usando medidas de desfecho bem estabelecidas e clinicamente relevantes, e com cálculo de tamanho amostral adequado.




Downloads

Dados de Download não estão ainda disponíveis.

Referências

1. White MC, Holman DM, Boehm JE, Peipins LA, Grossman M, Henley SJ. Age and cancer risk: a potentially modifiable relationship. Am J Prev Med. 2014;46(3 Suppl 1):S7-15.

2. Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, et al. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol. 2015;16(11):1193-224.

3. Handforth C, Clegg A, Young C, Simpkins S, Seymour MT, Selby PJ, et al. The prevalence and outcomes of frailty in older cancer patients: a systematic review. Ann Oncol. 2015;26(6):1091-101.

4. Fagard K, Leonard S, Deschodt M, Devriendt E, Wolthuis A, Prenen H, et al. The impact of frailty on postoperative outcomes in individuals aged 65 and over undergoing elective surgery for colorectal cancer: A systematic review. J Geriatr Oncol. 2016;7(6):479-91.

5. Oakland K, Nadler R, Cresswell L, Jackson D, Coughlin PA. Systematic review and meta-analysis of the association between frailty and outcome in surgical patients. Annals of the Royal College of Surgeons of England. 2016;98(2):80-5.

6. Merkow RP, Bentrem DJ, Mulcahy MF, Chung JW, Abbott DE, Kmiecik TE, et al. Effect of Postoperative Complications on Adjuvant Chemotherapy Use for Stage III Colon Cancer. Annals of Surgery. 2013;258(6):847-53.

7. Scheede-Bergdahl C, Minnella EM, Carli F. Multi-modal prehabilitation: addressing the why, when, what, how, who and where next? 2019;74(S1):20-6.

8. Carli F, Scheede-Bergdahl C. Prehabilitation to enhance perioperative care. Anesthesiol Clin. 2015;33(1):17-33.

9. Marmelo F, Rocha V, Moreira-Gonçalves D. The impact of prehabilitation on post-surgical complications in patients undergoing non-urgent cardiovascular surgical intervention: Systematic review and meta-analysis. European journal of preventive cardiology. 2018;25(4):404-17.

10. Moran J, Guinan E, McCormick P, Larkin J, Mockler D, Hussey J, et al. The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: A systematic review and meta-analysis. Surgery. 2016;160(5):1189-201.

11. Kamarajah SK, Bundred J, Weblin J, Tan BHL. Critical appraisal on the impact of preoperative rehabilitation and outcomes after major abdominal and cardiothoracic surgery: A systematic review and meta-analysis. Surgery. 2020;167(3):540-9.

12. Santa Mina D, Clarke H, Ritvo P, Leung YW, Matthew AG, Katz J, et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy. 2014;100(3):196-207.

13. Gillis C, Buhler K, Bresee L, Carli F, Gramlich L, Culos-Reed N, et al. Effects of Nutritional Prehabilitation, With and Without Exercise, on Outcomes of Patients Who Undergo Colorectal Surgery: A Systematic Review and Meta-analysis. Gastroenterology. 2018;155(2):391-410.e4.

14. Lau CSM, Chamberlain RS. Prehabilitation Programs Improve Exercise Capacity Before and After Surgery in Gastrointestinal Cancer Surgery Patients: A Meta-Analysis. Journal of Gastrointestinal Surgery. 2020;24(12):2829-37.

15. Palma S, Hasenoehrl T, Jordakieva G, Ramazanova D, Crevenna R. High-intensity interval training in the prehabilitation of cancer patients—a systematic review and meta-analysis. Supportive Care in Cancer. 2020.

16. Daniels SL, Lee MJ, George J, Kerr K, Moug S, Wilson TR, et al. Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta-analysis. BJS Open. 2020;4(6):1022-41.

17. Milder DA, Pillinger NL, Kam PCA. The role of prehabilitation in frail surgical patients: A systematic review. Acta anaesthesiologica Scandinavica. 2018;62(10):1356-66.

18. Karlsson E, Farahnak P, Franzén E, Nygren-Bonnier M, Dronkers J, van Meeteren N, et al. Feasibility of preoperative supervised home-based exercise in older adults undergoing colorectal cancer surgery – A randomized controlled design. PLoS ONE. 2019;14(7):1-21.

19. Barberan-Garcia A, Ubre M, Roca J, Lacy AM, Burgos F, Risco R, et al. Personalised Prehabilitation in High-risk Patients Undergoing Elective Major Abdominal Surgery: A Randomized Blinded Controlled Trial. Ann Surg. 2018;267(1):50-6.

20. Carli F, Bousquet-Dion G, Awasthi R, Elsherbini N, Liberman S, Boutros M, et al. Effect of Multimodal Prehabilitation vs Postoperative Rehabilitation on 30-Day Postoperative Complications for Frail Patients Undergoing Resection of Colorectal Cancer A Randomized Clinical Trial. JAMA surgery. 2020;155(3):233-42.

21. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

22. Higgins JPT TJ, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane Handbook for Systematic Reviews of Interventions versão 6.0Cochrane, 2019.

23. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. Bmj. 2003;327(7414):557-60.

24. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377-84.

25. Chia CL, Mantoo SK, Tan KY. ‘Start to finish trans-institutional transdisciplinary care’: a novel approach improves colorectal surgical results in frail elderly patients. Colorectal Dis. 2016;18(1):O43-50.

26. Mazzola M, Bertoglio C, Boniardi M, Magistro C, De Martini P, Carnevali P, et al. Frailty in major oncologic surgery of upper gastrointestinal tract: How to improve postoperative outcomes. Eur J Surg Oncol. 2017;43(8):1566-71.

27. Souwer ETD, Bastiaannet E, de Bruijn S, Breugom AJ, van den Bos F, Portielje JEA, et al. Comprehensive multidisciplinary care program for elderly colorectal cancer patients: “From prehabilitation to independence”. Eur J Surg Oncol. 2018;44(12):1894-900.

28. Baimas-George M, Watson M, Elhage S, Parala-Metz A, Vrochides D, Davis BR. Prehabilitation in Frail Surgical Patients: A Systematic Review. World Journal of Surgery. 2020;44(11):3668-78.

29. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242(3):326-41; discussion 41-3.

30. Tevis SE, Kohlnhofer BM, Stringfield S, Foley EF, Harms BA, Heise CP, et al. Postoperative complications in patients with rectal cancer are associated with delays in chemotherapy that lead to worse disease-free and overall survival. Dis Colon Rectum. 2013;56(12):1339-48.

31. Vasavada B, patel H. Non surgical procedure related postoperative Complications independently predicts perioperative mortality, in gastrointestinal and Hpb surgeries.- A retrospective Analysis of prospectively maintained data. medRxiv. 2020:2020.04.17.20068940.

32. Yabroff KR, Guy GP, Jr., Ekwueme DU, McNeel T, Rozjabek HM, Dowling E, et al. Annual patient time costs associated with medical care among cancer survivors in the United States. Med Care. 2014;52(7):594-601.

33. Couwenberg AM, de Beer FSA, Intven MPW, Burbach JPM, Smits AB, Consten ECJ, et al. The impact of postoperative complications on health-related quality of life in older patients with rectal cancer; a prospective cohort study. Journal of Geriatric Oncology. 2018;9(2):102-9.

34. Safieddine N, Xu W, Quadri SM, Knox JJ, Hornby J, Sulman J, et al. Health-related quality of life in esophageal cancer: effect of neoadjuvant chemoradiotherapy followed by surgical intervention. J Thorac Cardiovasc Surg. 2009;137(1):36-42.

35. Minnella EM, Awasthi R, Loiselle SE, Agnihotram RV, Ferri LE, Carli F. Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in Esophagogastric Cancer Surgery: A Randomized Clinical Trial. JAMA surgery. 2018;153(12):1081-9.

36. Aguayo GA, Donneau A-F, Vaillant MT, Schritz A, Franco OH, Stranges S, et al. Agreement Between 35 Published Frailty Scores in the General Population. American Journal of Epidemiology. 2017;186(4):420-34.
Publicado
2022-02-03
Como Citar
TEIXEIRA-OLIVEIRA, Fábio et al. PRÉ-HABILITAÇÃO E PROGNÓSTICO PÓS-OPERATÓRIO EM DOENTES ONCOLÓGICOS DE ALTO RISCO: UMA REVISÃO SISTEMÁTICA E META-ANÁLISE. Revista Portuguesa de Cirurgia, [S.l.], n. 51, p. 99-114, feb. 2022. ISSN 2183-1165. Disponível em: <https://revista.spcir.com/index.php/spcir/article/view/936>. Acesso em: 26 june 2022. doi: https://doi.org/10.34635/rpc.936.
Secção
Artigos Originais

Trabalhos mais lidos do mesmo autor(es)