Abstract：
BACKGROUND: Patients with peritoneal carcinomatosis often suffer from loss of skeletal muscle mass and require extensive surgery. Multimodal prehabilitation may improve physical status but its benefits for these specific patients remain unknown. This study aimed to evaluate the effect of prehabilitation on functional walking capacity and skeletal muscle mass, as well as its association with postoperative complications.
METHODS: A prospective study of patients with peritoneal carcinomatosis following a home-based trimodal prehabilitation program was carried out. Functional walking capacity was assessed with the 6-min walk test (T6MWT), and by the appendicular skeletal muscle index (ASMI) estimated by bioelectrical impedance analysis. Data were collected at the first medical appointment and on the day before surgery. A 90-day postoperative morbidity was registered according to the Clavien-Dindo classification.
RESULTS: A total of 62 patients were included in the analysis. Women were more prevalent (77.4%) and peritoneal metastasis from ovarian origin accounted for 48.4%. Clavien II-V grades occurred in 30 (57.7%) patients. After prehabilitation, functional walking capacity improved by 42.2 m (39.62-44.72 m) compared with baseline data (p < 0.001), but no improvement was observed in the ASMI (p = 0.301). Patients able to walk at least 360 m after prehabilitation suffered fewer Clavien-Dindo II-V postoperative complications (p = 0.016). A T6MWT of less than 360 m was identified as an independent risk factor in the multivariable analysis (OR 3.99; 1.01-15.79 p = 0.048).
CONCLUSIONS: This home-based trimodal prehabilitation program improved functional walking capacity but not ASMI scores in patients with peritoneal metastasis before surgery. A T6MWT of less than 360 m was found to be a risk factor for postoperative complications.
METHODS: A prospective study of patients with peritoneal carcinomatosis following a home-based trimodal prehabilitation program was carried out. Functional walking capacity was assessed with the 6-min walk test (T6MWT), and by the appendicular skeletal muscle index (ASMI) estimated by bioelectrical impedance analysis. Data were collected at the first medical appointment and on the day before surgery. A 90-day postoperative morbidity was registered according to the Clavien-Dindo classification.
RESULTS: A total of 62 patients were included in the analysis. Women were more prevalent (77.4%) and peritoneal metastasis from ovarian origin accounted for 48.4%. Clavien II-V grades occurred in 30 (57.7%) patients. After prehabilitation, functional walking capacity improved by 42.2 m (39.62-44.72 m) compared with baseline data (p < 0.001), but no improvement was observed in the ASMI (p = 0.301). Patients able to walk at least 360 m after prehabilitation suffered fewer Clavien-Dindo II-V postoperative complications (p = 0.016). A T6MWT of less than 360 m was identified as an independent risk factor in the multivariable analysis (OR 3.99; 1.01-15.79 p = 0.048).
CONCLUSIONS: This home-based trimodal prehabilitation program improved functional walking capacity but not ASMI scores in patients with peritoneal metastasis before surgery. A T6MWT of less than 360 m was found to be a risk factor for postoperative complications.
摘要：
背景：患有腹膜癌的患者通常会遭受骨骼肌质量损失并需要进行大量手术。多模式康复可能会改善身体状况，但对这些特定患者的益处尚不清楚。这项研究旨在评估康复对功能性步行能力和骨骼肌质量的影响，以及与术后并发症的关系。
方法：对腹膜癌病患者进行了一项前瞻性研究，该研究采用了以家庭为基础的三模式康复计划。通过6分钟步行测试（T6MWT）评估功能性步行能力，并通过生物电阻抗分析估算四肢骨骼肌指数（ASMI）。在第一次医疗预约和手术前一天收集数据。根据Clavien-Dindo分类记录了术后90天的发病率。
结果：共62例患者纳入分析。女性更为普遍（77.4％），卵巢来源的腹膜转移占48.4％。30例（57.7%）患者发生ClavienII-V级。经过训练,与基线数据相比，功能性步行能力提高了42.2m（39.62-44.72m）（p<0.001），但ASMI未见改善(p=0.301).能够在康复前行走至少360m的患者在Clavien-DindoII-V术后并发症较少（p=0.016）。在多变量分析中，小于360m的T6MWT被确定为独立的危险因素(OR3.99;1.01-15.79p=0.048)。
结论：这项以家庭为基础的三模式康复计划改善了腹膜转移患者手术前的功能性步行能力，但未改善ASMI评分。发现小于360m的T6MWT是术后并发症的危险因素。
方法：对腹膜癌病患者进行了一项前瞻性研究，该研究采用了以家庭为基础的三模式康复计划。通过6分钟步行测试（T6MWT）评估功能性步行能力，并通过生物电阻抗分析估算四肢骨骼肌指数（ASMI）。在第一次医疗预约和手术前一天收集数据。根据Clavien-Dindo分类记录了术后90天的发病率。
结果：共62例患者纳入分析。女性更为普遍（77.4％），卵巢来源的腹膜转移占48.4％。30例（57.7%）患者发生ClavienII-V级。经过训练,与基线数据相比，功能性步行能力提高了42.2m（39.62-44.72m）（p<0.001），但ASMI未见改善(p=0.301).能够在康复前行走至少360m的患者在Clavien-DindoII-V术后并发症较少（p=0.016）。在多变量分析中，小于360m的T6MWT被确定为独立的危险因素(OR3.99;1.01-15.79p=0.048)。
结论：这项以家庭为基础的三模式康复计划改善了腹膜转移患者手术前的功能性步行能力，但未改善ASMI评分。发现小于360m的T6MWT是术后并发症的危险因素。
