背景:接受根治性结直肠癌手术的患者术后发病率很高。建议进行康复治疗以降低术后发病率,然而,它的有效性仍然缺乏。
目的:本研究的目的是探讨康复治疗在降低结直肠癌手术患者术后发病率和住院时间方面的效果。
方法:在CINAHL中进行了全面的电子搜索,科克伦图书馆,Medline,心理信息,AMED,和Embase数据库从成立到2023年4月。测试康复效果的随机对照试验,包括锻炼,营养,和/或心理干预,与常规护理相比,接受结直肠癌手术的患者被纳入。两名独立的综述作者提取了相关信息并评估了偏倚的风险。随机效应荟萃分析用于汇集结果,并使用建议分级评估证据质量,评估,发展,和评估(等级)指南。
结果:共确定了23项试验(N=2475例患者),包括多模态(3次试验),锻炼(3次试验),营养(16项试验),和心理(1项试验)康复。有中等质量的证据表明,与对照组相比,术前营养显着减少了术后感染并发症(相对风险0.65,95%置信区间[CI]0.45-0.94),而低质量的证据则减少了住院时间(平均差异0.87,95%CI0.17-1.58)。一项试验证明了多模式康复对术后并发症的影响。
结论:营养康复在减少感染并发症和住院时间方面是有效的。无论是其他多式联运,锻炼,由于目前的证据质量较低,目前尚不确定结直肠癌手术后的预后和心理康复方式改善预后.
背景:开放科学框架(https://doi.org/10.17605/OSF.IO/VW72N)。
BACKGROUND: Postoperative morbidity in patients undergoing curative colorectal cancer surgery is high. Prehabilitation has been suggested to reduce postoperative morbidity, however its effectiveness is still lacking.
OBJECTIVE: The aim of this study was to investigate the effectiveness of prehabilitation in reducing postoperative morbidity and length of hospital stay in patients undergoing colorectal cancer surgery.
METHODS: A comprehensive electronic search was conducted in the CINAHL, Cochrane Library, Medline, PsychINFO, AMED, and Embase databases from inception to April 2023. Randomised controlled trials testing the effectiveness of prehabilitation, including exercise, nutrition, and/or psychological interventions, compared with usual care in patients undergoing colorectal cancer surgery were included. Two independent
review authors extracted relevant information and assessed the risk of bias. Random-effect meta-analyses were used to pool outcomes, and the quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines.
RESULTS: A total of 23 trials were identified (N = 2475 patients), including multimodal (3 trials), exercise (3 trials), nutrition (16 trials), and psychological (1 trial) prehabilitation. There was moderate-quality evidence that preoperative nutrition significantly reduced postoperative infectious complications (relative risk 0.65, 95% confidence interval [CI] 0.45-0.94) and low-quality evidence on reducing the length of hospital stay (mean difference 0.87, 95% CI 0.17-1.58) compared with control. A single trial demonstrated an effect of multimodal prehabilitation on postoperative complication.
CONCLUSIONS: Nutrition prehabilitation was effective in reducing infectious complications and length of hospital stay. Whether other multimodal, exercise, and psychological prehabilitation modalities improve postoperative outcomes after colorectal cancer surgery is uncertain as the current quality of evidence is low.
BACKGROUND: Open Science Framework ( https://doi.org/10.17605/OSF.IO/VW72N ).