Scripties UMCG - Rijksuniversiteit Groningen
 
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An Observational Study determining the Possiblilities for Prerehabilitation in Patients scheduled for liver or pancreatic Tumor Resection

(2017) Wijk, L. van (Laura)

Background:
Morbidity and mortality rates after resection of hepatic and pancreatic tumors are relatively high. Unfit patients, are more prone to complications. Preoperative risk stratification with subsequent necessary interventions (prehabilitation) can improve the overall condition of these patients and reduce perioperative complications. Prehabilitation focuses at different levels such as exercise, hemoglobin level, nutrition and psychosocial approaches.
In this study, we aimed to gain more insight in the possibilities for prehabilitation in hepato pancreato biliary (HPB) cancer patients.
Methods:
From oncologic patients who were scheduled for HPB surgery in July or August 2017, their cardiopulmonary fitness was measured by the Veterans Specific Activity Questionnaire (VSAQ). If the score was <7 metabolic equivalent (MET), they performed a Cardio Pulmonary Exercise Test (CPET). From patients who underwent an oncologic liver- or pancreatic resection in 2015 or 2016, we retrospectively analyzed their hemoglobin level, nutritional status, and postoperative complications.
Results:
Eleven of the twenty-two patients scored <7 MET at the VSAQ. Of them, 7 patients performed a CPET, of whom 71% had an aerobic threshold < 11 ml/min/kg.
Of 276 HPB patients, 28,2% had surgery in an anemic state and 26,6% in an undernourished state. Postoperative complications occurred significantly (p 0.003 and p 0.020) more often in anemic or undernourished patients. Multivariate analysis showed an adjusted OR 2,019 (95% CI: 1,0-4,2) for the anemic patients and an adjusted OR 1,352 (95% CI: 0,7 -2,8) for the malnourished patients. Anemic patients were 6,5 times as likely to receive a perioperative transfusion (95% CI: 1,9-21,9; p=0,002) compared with patients without anemia.
Discussion:
HPB cancer patients are susceptible to get in an anemic, physical unfit, and undernourished state. This is associated with a higher risk at postoperative complications. Further research should be focused at the implementation of preoperative optimization (prehabilitation) of the patient.






 
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