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Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: A pooled analysis of randomized controlled trials.
Clin Nutr 2019; 38(3):1053-1060CN

Abstract

BACKGROUND & AIMS

Preservation of lean body mass is an important cancer care objective. The capacity for prehabilitation interventions to modulate the lean body mass (LBM) of colorectal cancer patients before and after surgery is unknown.

METHODS

A pooled analysis of two randomized controlled trials of trimodal prehabilitation vs. trimodal rehabilitation at a single university-affiliated tertiary center employing Enhanced Recovery After Surgery (ERAS) care was conducted. The prehabilitation interventions included exercise, nutrition, and anxiety-reduction elements that began approximately four weeks before surgery and continued for eight weeks after surgery. The rehabilitation interventions were identical to the prehabilitation interventions but were initiated only after surgery. Body composition, measured using multifrequency bioelectrical impedance analysis, was recorded at baseline, pre-surgery, 4 and 8 weeks after surgery. The primary outcome was change in LBM before and after colorectal surgery for cancer. A mixed effects regression model was used to estimate changes in body mass and body composition over time controlling for age, sex, baseline body mass index (BMI), baseline six-minute walk test (6MWT), and postoperative compliance to the interventions. NCT02586701 &NCT01356264.

RESULTS

Pooled data included 76 patients who followed prehabilitation and 63 patients who followed rehabilitation (n = 139). Neither group experienced changes in preoperative LBM. Compared to rehabilitated patients, prehabilitated patients had significantly more absolute and relative LBM at four and eight-weeks post-surgery in models controlling for age, sex, baseline BMI, baseline 6MWT, and compliance to the postoperative intervention.

CONCLUSION

Trimodal prehabilitation attenuated the post-surgical LBM loss compared to the loss observed in patients who received the rehabilitation intervention. Patients who receive neither intervention (i.e., standard of care) would be likely to lose more LBM. Offering a prehabilitation program to colorectal cancer patients awaiting resection is a useful strategy to mitigate the impact of the surgical stress response on lean tissue in an ERAS setting, and, in turn, might have a positive impact on the cancer care course.

CLINICAL TRIAL REGISTRATION

NCT02586701 &NCT01356264 (clinicaltrials.gov).

Authors+Show Affiliations

Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, AB, Canada. Electronic address: chelsia.gillis@ucalgary.ca.Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, and Nutrition Services, Alberta Health Services, AB, Canada.Cumming School of Medicine, Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.Department of Anesthesia, McGill University, Montreal, QC, Canada.Department of Anesthesia, McGill University, Montreal, QC, Canada.Department of Nutrition and Food Services, McGill University, Montreal, QC, Canada.Department of Surgery, McGill University, Montreal, QC, Canada.Department of Surgery, McGill University, Montreal, QC, Canada.Department of Surgery, McGill University, Montreal, QC, Canada.Department of Anesthesia, McGill University, Montreal, QC, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30025745

Citation

Gillis, Chelsia, et al. "Trimodal Prehabilitation for Colorectal Surgery Attenuates Post-surgical Losses in Lean Body Mass: a Pooled Analysis of Randomized Controlled Trials." Clinical Nutrition (Edinburgh, Scotland), vol. 38, no. 3, 2019, pp. 1053-1060.
Gillis C, Fenton TR, Sajobi TT, et al. Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: A pooled analysis of randomized controlled trials. Clin Nutr. 2019;38(3):1053-1060.
Gillis, C., Fenton, T. R., Sajobi, T. T., Minnella, E. M., Awasthi, R., Loiselle, S. È., ... Carli, F. (2019). Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: A pooled analysis of randomized controlled trials. Clinical Nutrition (Edinburgh, Scotland), 38(3), pp. 1053-1060. doi:10.1016/j.clnu.2018.06.982.
Gillis C, et al. Trimodal Prehabilitation for Colorectal Surgery Attenuates Post-surgical Losses in Lean Body Mass: a Pooled Analysis of Randomized Controlled Trials. Clin Nutr. 2019;38(3):1053-1060. PubMed PMID: 30025745.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trimodal prehabilitation for colorectal surgery attenuates post-surgical losses in lean body mass: A pooled analysis of randomized controlled trials. AU - Gillis,Chelsia, AU - Fenton,Tanis R, AU - Sajobi,Tolulope T, AU - Minnella,Enrico Maria, AU - Awasthi,Rashami, AU - Loiselle,Sarah-Ève, AU - Liberman,A Sender, AU - Stein,Barry, AU - Charlebois,Patrick, AU - Carli,Francesco, Y1 - 2018/07/09/ PY - 2018/05/03/received PY - 2018/06/21/revised PY - 2018/06/25/accepted PY - 2018/7/22/pubmed PY - 2018/7/22/medline PY - 2018/7/21/entrez KW - Body composition KW - ERAS KW - LBM KW - Prehab KW - Preoperative KW - Surgical preparation SP - 1053 EP - 1060 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 38 IS - 3 N2 - BACKGROUND & AIMS: Preservation of lean body mass is an important cancer care objective. The capacity for prehabilitation interventions to modulate the lean body mass (LBM) of colorectal cancer patients before and after surgery is unknown. METHODS: A pooled analysis of two randomized controlled trials of trimodal prehabilitation vs. trimodal rehabilitation at a single university-affiliated tertiary center employing Enhanced Recovery After Surgery (ERAS) care was conducted. The prehabilitation interventions included exercise, nutrition, and anxiety-reduction elements that began approximately four weeks before surgery and continued for eight weeks after surgery. The rehabilitation interventions were identical to the prehabilitation interventions but were initiated only after surgery. Body composition, measured using multifrequency bioelectrical impedance analysis, was recorded at baseline, pre-surgery, 4 and 8 weeks after surgery. The primary outcome was change in LBM before and after colorectal surgery for cancer. A mixed effects regression model was used to estimate changes in body mass and body composition over time controlling for age, sex, baseline body mass index (BMI), baseline six-minute walk test (6MWT), and postoperative compliance to the interventions. NCT02586701 &NCT01356264. RESULTS: Pooled data included 76 patients who followed prehabilitation and 63 patients who followed rehabilitation (n = 139). Neither group experienced changes in preoperative LBM. Compared to rehabilitated patients, prehabilitated patients had significantly more absolute and relative LBM at four and eight-weeks post-surgery in models controlling for age, sex, baseline BMI, baseline 6MWT, and compliance to the postoperative intervention. CONCLUSION: Trimodal prehabilitation attenuated the post-surgical LBM loss compared to the loss observed in patients who received the rehabilitation intervention. Patients who receive neither intervention (i.e., standard of care) would be likely to lose more LBM. Offering a prehabilitation program to colorectal cancer patients awaiting resection is a useful strategy to mitigate the impact of the surgical stress response on lean tissue in an ERAS setting, and, in turn, might have a positive impact on the cancer care course. CLINICAL TRIAL REGISTRATION: NCT02586701 &NCT01356264 (clinicaltrials.gov). SN - 1532-1983 UR - https://www.unboundmedicine.com/medline/citation/30025745/Trimodal_prehabilitation_for_colorectal_surgery_attenuates_post_surgical_losses_in_lean_body_mass:_A_pooled_analysis_of_randomized_controlled_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0261-5614(18)31201-9 DB - PRIME DP - Unbound Medicine ER -