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Ernährungsmedizinische Konditionierung vor Tumoroperationen – Prähabilitation

Preoperative nutritional conditioning for patients with cancer—prehabilitation

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

In einer primär übergewichtigen Gesellschaft wird das Bestehen einer Mangelernährung, oftmals maskiert durch eine sarkopene Adipositas, häufig unterschätzt. Mangelernährung und Sarkopenie sind prädiktive Faktoren für die Entwicklung postoperativer Komplikationen.

Methoden

Das präoperative Ernährungsscreening und ggf. die Erhebung des Ernährungsstatus sowie bei entsprechender Komorbidität auch die Bestimmung der Funktionalität sind unverzichtbar.

Ergebnisse

Im Fall manifester Defizite wird vor der Operation eine trimodale „Prähabilitation“, welche körperliches Ausdauer- und Krafttraining, Ernährungstherapie und psychologische Unterstützung umfasst, empfohlen. Geeignet ist eine Zeitspanne von 4–6 Wochen, insbesondere nach neoadjuvanter Therapie. Ziel ist es, den Patienten mit Ernährungstherapie zu konditionieren, um postoperative Komplikationen zu vermeiden und eine rasche Erholung (Enhanced Recovery After Surgery = ERAS) zu ermöglichen.

Schlussfolgerung

Eine trimodale „Prähabilitation“ mit körperlichem Ausdauer- und Krafttraining, Ernährungstherapie und psychologischer Unterstützung über 4–6 Wochen dient der rascheren Erholung nach Operationen (ERAS-Programm). Bisher fehlen hierfür im deutschen Gesundheitssystem geeignete sektoreübergreifende Strukturen.

Abstract

Background

While hidden by sarcopenic obesity, malnutrition may be neglected in an overweight society. Malnutrion and sarcopenia are predictive factors for the development of complications in patients undergoing major surgery.

Methods

Preoperative screening and assessment of nutritional status is mandatory. Comorbidity associated functional limitations may be also assessed by additional tests.

Results

In case of manifest deficits, trimodal “prehabilitation”, which includes physical endurance and power training, nutritional therapy, and psychological coaching, is recommended prior to surgery. A preoperative period of 4–6 weeks seems to be appropriate, especially with regard to neoadjuvant treatment. Prehabilitation focuses on conditioning the high-risk patient individually and multimodally, including nutrition therapy (“fit for ERAS”, enhanced recovery after surgery) in order to attenuate postoperative catabolism, decrease complication rates, and enhance postoperative recovery.

Conclusion

Trimodal “prehabilitation” with physical endurance and strength training, nutritional therapy and psychological support over 4–6 weeks serves to accelerate recovery after surgery (ERAS program). Currently, appropriate cross-sectoral approaches for this are still lacking in the German health care system.

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Authors and Affiliations

  1. Klinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Delitzscher Str. 141, 04129, Leipzig, Deutschland

    Maria Wobith &  Arved Weimann

  2. Klinik für Viszeral‑, Transplantations‑, Gefäß- und Thoraxchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    Ines Gockel

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  1. Maria Wobith
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Correspondence to Arved Weimann.

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Interessenkonflikt

A. Weimann weist auf folgende Beziehungen hin: Vorträge: Baxter/Deutschland GmbH, B. Braun/Melsungen AG, Fresenius Kabi Deutschland GmbH, Ethicon, Falk Foundation; Forschungssförderung: Baxter, Mucos. M. Wobith und I. Gockel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Wobith, M., Gockel, I. & Weimann, A. Ernährungsmedizinische Konditionierung vor Tumoroperationen – Prähabilitation. Onkologe 27, 129–138 (2021). https://doi.org/10.1007/s00761-020-00855-x

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