结直肠癌癌症手术前基于家庭的多模式康复：一项系统综述和荟萃分析

摘要(中文译文)

多模式康复方案是一类综合性的术前干预策略，旨在优化患者的身体、营养和心理状态。这些方案在促进康复、改善生活质量和优化功能结局方面已在多种临床情境中显示出潜在获益。本综述旨在评估基于家庭的多模式预康复对接受结直肠癌手术患者的可行性和临床有效性。采用RevMan 5.4进行系统评价和荟萃分析。主要结局为术前6分钟步行试验（6MWT）的变化。次要结局包括术后30天并发症、急诊就诊、再入院以及采用医院焦虑抑郁量表（HADS）评估的心理健康结局。预康复显著改善了术前6MWT[MD=40.61，95%CI（6.23，74.99），P=0.02]。然而，在术后4~6周[MD=49.67，95%CI（-35.50，134.84），P=0.25]或8周[MD=26.58，95%CI（-8.88，62.04），P=0.14]时未观察到显著改善。预康复对总住院时间、术后30天并发症、急诊就诊或再入院率均无显著影响。此外，8周时HADS焦虑或HADS抑郁评分均未见显著改善。基于家庭的多模式预康复显著改善了结直肠癌手术前的身体功能；然而，这些获益在术后未能维持。可能需要更强化或更长时间的方案，并结合术后康复，以维持术前所获得的改善。需要更大规模、随访时间更长的试验来确认长期临床效果。该研究方案已在PROSPERO注册（CRD42023439715）。

Abstract

Multimodal rehabilitation programs represented comprehensive preoperative intervention strategies designed to optimize patients' physical, nutritional, and psychological status. These programs have shown potential benefits in enhancing recovery, improving quality of life, and optimizing functional outcomes across various clinical contexts. This review aimed to evaluate the feasibility and clinical effectiveness of home-based multimodal prehabilitation for patients undergoing colorectal cancer surgery. A systematic review and meta-analysis were conducted using RevMan 5.4. The primary outcome was the change in the 6-min walk test (6MWT) during the preoperative period. Secondary outcomes included 30-day postoperative complications, emergency department visits, hospital readmission, and mental health outcomes measured using the Hospital Anxiety and Depression Scale (HADS). Prehabilitation significantly improved the preoperative 6MWT [MD = 40.61, 95% CI (6.23, 74.99), P = 0.02]. However, no significant improvement was observed at 4-6 weeks [MD = 49.67, 95% CI (-35.50, 134.84), P = 0.25] or 8 weeks postoperatively [MD = 26.58, 95% CI (-8.88, 62.04), P = 0.14]. Prehabilitation did not significantly affect total hospitalization, 30-day postoperative complications, emergency department visits, or readmission rates. Additionally, no significant improvements were found in HADS-anxiety or HADS-depression scores at 8 weeks. Home-based multimodal prehabilitation significantly improved physical function before colorectal cancer surgery; however, these benefits were not sustained postoperatively. More intensive or prolonged programs, combined with postoperative rehabilitation, may be necessary to maintain preoperative gains. Larger trials with extended follow-up periods are needed to confirm long-term clinical effects. The study protocol was registered in PROSPERO (CRD42023439715).

如何引用

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 的其他文献

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