PDF(Pubmed)
Abstract：
BACKGROUND: Meta-analyses have primarily focused on the effects of exercise-based prehabilitation on postoperative outcomes and ignored the role of nutritional intervention. In this study, we filled this gap by investigating the effect of nutrition-based prehabilitation on the postoperative outcomes of patients who underwent esophagectomy and gastrectomy.
METHODS: Five electronic databases, namely, PubMed, the Web of Science, Embase, Cochrane Library, and CINAHL, were searched. Adults diagnosed with esophagogastric cancer who were scheduled to undergo surgery and had undergone uni- or multimodal prehabilitation, with at least a week of mandatory nutritional intervention, were included. Forest plots were used to extract and visualize the data from the included studies. The occurrence of any postoperative complication was considered the primary endpoint.
RESULTS: Eight studies met the eligibility criteria, with five randomized controlled trials (RCTs) and three cohort studies. In total, 661 patients were included. Any prehabilitation, that is, unimodal (only nutrition) and multimodal prehabilitation, collectively decreased the risk of any postoperative complication by 23% (95% confidence interval [CI] = 0.66-0.90). A similar effect was exclusively observed for multimodal prehabilitation (risk ratio [RR] = 0.78, 95% CI = 0.66-0.93); however, it was not significant for unimodal prehabilitation. Any prehabilitation significantly decreased the length of hospital stay (LOS) (weighted mean difference = -0.77, 95% CI = -1.46 to -0.09).
CONCLUSIONS: Nutrition-based prehabilitation, particularly multimodal prehabilitation, confers protective effects against postoperative complications after esophagectomy and gastrectomy. Our findings suggest that prehabilitation slightly decreases LOS; however, the finding is not clinically significant. Therefore, additional rigorous RCTs are warranted for further substantiation.
METHODS: Five electronic databases, namely, PubMed, the Web of Science, Embase, Cochrane Library, and CINAHL, were searched. Adults diagnosed with esophagogastric cancer who were scheduled to undergo surgery and had undergone uni- or multimodal prehabilitation, with at least a week of mandatory nutritional intervention, were included. Forest plots were used to extract and visualize the data from the included studies. The occurrence of any postoperative complication was considered the primary endpoint.
RESULTS: Eight studies met the eligibility criteria, with five randomized controlled trials (RCTs) and three cohort studies. In total, 661 patients were included. Any prehabilitation, that is, unimodal (only nutrition) and multimodal prehabilitation, collectively decreased the risk of any postoperative complication by 23% (95% confidence interval [CI] = 0.66-0.90). A similar effect was exclusively observed for multimodal prehabilitation (risk ratio [RR] = 0.78, 95% CI = 0.66-0.93); however, it was not significant for unimodal prehabilitation. Any prehabilitation significantly decreased the length of hospital stay (LOS) (weighted mean difference = -0.77, 95% CI = -1.46 to -0.09).
CONCLUSIONS: Nutrition-based prehabilitation, particularly multimodal prehabilitation, confers protective effects against postoperative complications after esophagectomy and gastrectomy. Our findings suggest that prehabilitation slightly decreases LOS; however, the finding is not clinically significant. Therefore, additional rigorous RCTs are warranted for further substantiation.
摘要：
背景：Meta分析主要关注基于运动的康复对术后结局的影响，而忽略了营养干预的作用。在这项研究中,我们通过研究以营养为基础的康复治疗对行食管切除术和胃切除术患者术后结局的影响,填补了这一空白.
方法：五个电子数据库，即,PubMed,WebofScience,Embase,科克伦图书馆,和CINAHL，被搜查了。被诊断患有食管胃癌的成年人计划接受手术并接受了单模式或多模式康复治疗，至少一周的强制性营养干预，包括在内。森林地块用于从所包括的研究中提取和可视化数据。任何术后并发症的发生被认为是主要终点。
结果：8项研究符合资格标准，5项随机对照试验（RCTs）和3项队列研究。总的来说,纳入661例患者。任何康复治疗，也就是说,单峰（仅营养）和多模式康复，术后并发症风险降低23%(95%置信区间[CI]=0.66-0.90).对于多模式前康复仅观察到类似的效果（风险比[RR]=0.78，95％CI=0.66-0.93）；但是，对于单峰前康复并不重要.任何康复治疗都显着降低了住院时间（LOS）（加权平均差=-0.77，95％CI=-1.46至-0.09）。
结论：基于营养的康复，特别是多模式的康复，对食管癌和胃切除术后的并发症有保护作用。我们的研究结果表明，康复治疗会稍微降低LOS；然而，这一发现没有临床意义.因此,需要额外严格的随机对照试验以进一步证实.
方法：五个电子数据库，即,PubMed,WebofScience,Embase,科克伦图书馆,和CINAHL，被搜查了。被诊断患有食管胃癌的成年人计划接受手术并接受了单模式或多模式康复治疗，至少一周的强制性营养干预，包括在内。森林地块用于从所包括的研究中提取和可视化数据。任何术后并发症的发生被认为是主要终点。
结果：8项研究符合资格标准，5项随机对照试验（RCTs）和3项队列研究。总的来说,纳入661例患者。任何康复治疗，也就是说,单峰（仅营养）和多模式康复，术后并发症风险降低23%(95%置信区间[CI]=0.66-0.90).对于多模式前康复仅观察到类似的效果（风险比[RR]=0.78，95％CI=0.66-0.93）；但是，对于单峰前康复并不重要.任何康复治疗都显着降低了住院时间（LOS）（加权平均差=-0.77，95％CI=-1.46至-0.09）。
结论：基于营养的康复，特别是多模式的康复，对食管癌和胃切除术后的并发症有保护作用。我们的研究结果表明，康复治疗会稍微降低LOS；然而，这一发现没有临床意义.因此,需要额外严格的随机对照试验以进一步证实.
