基于运动的术前康复在结直肠癌手术治疗中的效果和持续时间：系统评价和荟萃分析。
Effects and duration of exercise-based prehabilitation in surgical therapy of colon and rectal cancer: a systematic review and meta-analysis.
机构信息
Institute of Sport Medicine and Prevention, University Leipzig, Rosa-Luxemburg-Str. 20-30, 04103, Leipzig, Germany.
Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany.
出版信息
J Cancer Res Clin Oncol. 2022 Sep;148(9):2187-2213. doi: 10.1007/s00432-022-04088-w. Epub 2022 Jun 13.
PURPOSE
Functional capacity is an independent indicator of morbidity in colon and rectal cancer surgery. This systematic review describes the evaluated and synthesized effects of exercise prehabilitation depending on the duration of interventions on functional and postoperative outcomes in colon and rectal cancer surgery.
METHODS
Three electronic databases (MEDLINE Pubmed, Web of Sciences, and Cochrane Registry) were systematically searched (January 2022) for controlled trials that investigated the effects of prehabilitation prior to colo-rectal cancer resection.
RESULTS
Twenty-three studies were included in this systematic review and 14 in our meta-analyses assessing these outcomes: the 6 min walk distance (6MWD), postoperative overall complications, and length of stay (LOS). We observed a significant improvement in preoperative functional capacity as measured with 6MWD (mean difference: 30.8 m; 95% CI 13.3, 48.3; p = 0.0005) due to prehabilitation. No reductions in LOS (mean difference: - 0.27 days; 95% CI - 0.93, 0.40; p = 0.5) or postoperative overall complications (Odds ratio: 0.84; 95% CI 0.53, 1.31; p = 0.44) were observed. Prehabilitation lasting more than 3 weeks tended to lower overall complications (Odds ratio: 0.66; 95% CI 0.4, 1.1; p = 0.11). However, the prehabilitation time periods differed between colon and rectal carcinoma resections.
CONCLUSION
Prehabilitation while the patient is preparing to undergo surgery for colorectal carcinoma improves functional capacity; and might reduce postoperative overall complications, but does not shorten the LOS. The studies we reviewed differ in target variables, design, and the intervention's time period. Multicenter studies with sufficient statistical power and differentiating between colon and rectal carcinoma are needed to develop implementation strategies in the health care system.
REGISTRATION
PROSPERO CRD42022310532.
目的
功能能力是结直肠癌手术发病率的独立指标。本系统评价描述了根据干预持续时间评估和综合的运动预康复对结直肠癌手术的功能和术后结果的影响。
方法
系统检索了三个电子数据库（MEDLINE Pubmed、Web of Sciences 和 Cochrane Registry）（2022 年 1 月），以寻找调查结直肠切除术前预康复效果的对照试验。
结果
本系统评价纳入了 23 项研究，14 项研究纳入了我们的荟萃分析，评估了这些结果：6 分钟步行距离（6MWD）、术后总体并发症和住院时间（LOS）。我们观察到由于预康复，术前功能能力有显著改善，以 6MWD 衡量（平均差异：30.8m；95%CI 13.3，48.3；p=0.0005）。没有观察到 LOS（平均差异：-0.27 天；95%CI-0.93，0.40；p=0.5）或术后总体并发症（比值比：0.84；95%CI 0.53，1.31；p=0.44）减少。持续时间超过 3 周的预康复倾向于降低总体并发症（比值比：0.66；95%CI 0.4，1.1；p=0.11）。然而，结肠癌和直肠癌切除术之间的预康复时间不同。
结论
在准备接受结直肠癌手术的患者中进行预康复可以提高功能能力；并且可能降低术后总体并发症，但不会缩短 LOS。我们回顾的研究在目标变量、设计和干预持续时间上存在差异。需要进行具有足够统计效力的多中心研究，并区分结肠癌和直肠癌，以便在医疗保健系统中制定实施策略。
注册
PROSPERO CRD42022310532。
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