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Clinical Benefit of Preoperative Exercise and Nutritional Therapy for Patients Undergoing Hepato-Pancreato-Biliary Surgeries for Malignancy

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The impact of prehabilitation on physical fitness and postoperative course after hepato-pancreato-biliary (HPB) surgeries for malignancy is unknown. The current study aimed to investigate the effect of preoperative exercise and nutritional therapies on nutritional status, physical fitness, and postoperative outcomes of patients undergoing an invasive HPB surgery for malignancy.

Methods

Patients who underwent open abdominal surgeries for HPB malignancies (major hepatectomy, pancreatoduodenectomy, or hepato-pancreatoduodenectomy) between 2016 and 2017 were subjected to prehabilitation. Patients before the introduction of prehabilitation were included as historical control subjects for 1:1 propensity score-matching (no-prehabilitation group). The preoperative nutritional status and postoperative course were compared between the two groups.

Results

The prehabilitation group consisted of 76 patients scheduled to undergo HPB surgeries for malignancy. An identical number of patients were selected as the no-prehabilitation group after propensity score-matching. During the waiting period, serum albumin levels were significantly deteriorated in the no-prehabilitation group, whereas this index did not deteriorate or even improved in the prehabilitation group. By performing prehabilitation, a 6-min walk distance and total muscle/fat ratio were significantly increased during the waiting period. Although the overall incidence of postoperative complications did not differ between the two groups, the postoperative hospital stay was shorter in the prehabilitation group than in the no-prehabilitation group (median, 23 vs 30 days; p = 0.045).

Conclusion

The introduction of prehabilitation prevented nutritional deterioration, improved physical fitness before surgery, and shortened the postoperative hospital stay for the patients undergoing HPB surgeries for malignancy.

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Acknowledgments

This work was supported in part by Grants-in-Aid for Scientific Research (no. 16K21081 to T. Inoue) from the Ministry of Education, Culture, Sports, and Science and Technology of Japan. We sincerely thank all the patients, collaborating physicians, and other medical staff for their important contributions to this study.

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Authors and Affiliations

  1. Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan

    Hiroki Nakajima PT, Takayuki Inoue PT, PhD, Motoki Nagaya PT, MSc, Yota Mizuno PT, Izumi Kadono MD & Yoshihiro Nishida MD

  2. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8550, Japan

    Yukihiro Yokoyama MD & Masato Nagino MD

  3. Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Izumi Kadono MD & Yoshihiro Nishida MD

  4. Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Kimitoshi Nishiwaki MD

Authors
  1. Hiroki Nakajima PT
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  2. Yukihiro Yokoyama MD
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  3. Takayuki Inoue PT, PhD
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  4. Motoki Nagaya PT, MSc
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  5. Yota Mizuno PT
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  6. Izumi Kadono MD
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  7. Kimitoshi Nishiwaki MD
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  8. Yoshihiro Nishida MD
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  9. Masato Nagino MD
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Corresponding author

Correspondence to Yukihiro Yokoyama MD.

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Disclosure

The authors affirm that they have no financial or personal affiliations (including research funding) or other involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript.

Electronic supplementary material

Below is the link to the electronic supplementary material.

FIG. S1 Flow chart of the study participants. (PDF 122 kb)

10434_2018_6943_MOESM2_ESM.pdf

FIG. S2 Correlation between the serum albumin and the 6-min walk distance (6MWD) at the second hospitalization. The correlation between the two variables was determined by Spearman’s rank correlation coefficient. (PDF 69 kb)

Supplementary material 3 (DOCX 12 kb)

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Nakajima, H., Yokoyama, Y., Inoue, T. et al. Clinical Benefit of Preoperative Exercise and Nutritional Therapy for Patients Undergoing Hepato-Pancreato-Biliary Surgeries for Malignancy. Ann Surg Oncol 26, 264–272 (2019). https://doi.org/10.1245/s10434-018-6943-2

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  • DOI: https://doi.org/10.1245/s10434-018-6943-2

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