Preoperative multimodal prehabilitation in abdominal oncology:

OBJECTIVE: To evaluate the impact of multimodal prehabilitation, including a structured proprietary kinesiotherapy program with a video-guided module, on early postoperative outcomes in elder patients after gastropancreatoduodenectomy, gastrectomy and low anterior rectal resection. MATERIAL AND METHODS: A single-center two-stage comparative cohort study (retrospective and prospective cohorts) included 216 patients (108 in the prehabilitation group and 108 in the control group). Both groups used an accelerated recovery protocol after surgery. The study group additionally underwent a 14-day multimodal prehabilitation program with original video-guided kinesiotherapy program. The primary endpoint was any postoperative complication within 30 days. Secondary endpoints included severity of complications (Clavien-Dindo classification), length of ICU- and hospital-stay and time to adjuvant chemotherapy. RESULTS: The incidence of postoperative complications was 18.6% and 41.7%, respectively. No severe complications (Clavien-Dindo grade IIIb-V) were reported in the prehabilitation group, whereas high-grade complications, including one death, were observed in the control group. Prehabilitation was associated with shorter ICU- and hospital-stay, as well as a trend towards earlier initiation of adjuvant chemotherapy. In multivariate analysis, prehabilitation was associated with lower risk of postoperative complications. CONCLUSION: A structured multimodal prehabilitation with video-guided kinesiotherapy is associated with better early postoperative outcomes in elderly patients after abdominal surgeries for cancer.