Prähabilitation

Die Prähabilitation widmet sich der präoperativen Phase, in der der Patient optimal auf einen großen chirurgischen Eingriff vorbereitet werden soll. In einem multimodalen Konzept, welches Ernährungs- und Bewegungstherapie, psychologische Unterstützung und ein Patient Blood Management einbezieht, werden so Voraussetzungen gesetzt, den Patienten postoperativ schnell wieder fit zu machen und in die Häuslichkeit zu entlassen.

Kernaussagen

• Die Prähabilitation nutzt die mehrwöchige präoperative Phase, um den Patienten vor einem großen abdominalchirurgischen Eingriff optimal auf die Operation vorzubereiten.

• Dabei werden modifizierbare Risikofaktoren adressiert, wie Mangelernährung, eine Eisenmangelanämie, Sarkopenie, verringerte funktionelle Kapazität.

• Eine multimodale Prähabilitation besteht aus Ernährungs- und Bewegungstherapie, psychologischer Unterstützung und ggf. einem Patient Blood Management.

• Anhand der derzeitigen Evidenzlage können keine eindeutigen Empfehlungen gegeben werden, welche Maßnahmen in welcher Intensität und in welchem Zeitraum durchzuführen sind.

Schlüsselwörter

Prähabilitation - Viszeralchirurgie - präoperative Ernährungs- und Bewegungstherapie

Publication History

Article published online:
26 September 2022

• Literatur

• 1 Martin L, Gillis C, Atkins M. et al. Implementation of an Enhanced Recovery After Surgery Program can change nutrition care practice: A multicenter experience in elective colorectal surgery. JPEN J Parenter Enteral Nutr 2019; 43: 206-219 DOI: 10.1002/jpen.1417.
• 2 Baum P, Diers J, Lichthardt S. et al. Mortality and complications following visceral surgery. Dtsch Arztebl Int 2019; 116: 739-746 DOI: 10.3238/arztebl.2019.0739.
• 3 Olotu C, Weimann A, Bahrs C. et al. The perioperative care of older patients–Time for a new, interdisciplinary approach. Dtsch Arztebl Int 2019; 116: 63-69 DOI: 10.3238/arztebl.2019.0063.
• 4 Weimann A, Braga M, Carli F. et al. ESPEN Guideline Clinical Nutrition in Surgery. Clin Nutr 2017; 36: 623-650 DOI: 10.1016/j.clnu.2017.02.013.
• 5 Cruz-Jentoft AJ, Baeyens JP, Bauer JM. et al. Sarcopenia: European consensus on definition and diagnosis. Age Ageing 2019; 39: 412-423 DOI: 10.1093/ageing/afq03.
• 6 Simonsen C, de Heer P, Bjerre ED. et al. Sarcopenia and postoperative complication risk in gastrointestinal surgical oncology: a meta-analysis. Ann Surg 2018; 268: 58-69 DOI: 10.1097/SLA.0000000000002679.
• 7 Jensen GL, Cederholm T, Correia MTD. et al. GLIM criteria for the diagnosis of malnutrition. a consensus report from the global clinical nutrition community. JPEN J Parenter Enteral Nutr 2019; 43: 32-40 DOI: 10.1002/jpen.1440.
• 8 Gruber ES, Jomrich G, Tamandl D. et al. Sarcopenia and sarcopenic obesity are independent adverse prognostic factors in resectable pancreatic ductal adenocarcinoma. PLoS One 2019; 14: e0215915 DOI: 10.1371/journal.pone.0215915.
• 9 Martin L, Gioulbasanis I, Senesse P. et al. Cancer-associated malnutrition and CT-defined sarcopenia and Myosteatosis are endemic in overweight and obese patients. JPEN J Parenter Enteral Nutr 2020; 44: 227-238 DOI: 10.1002/jpen.1597.
• 10 Argillander TE, Spek D, van der Zaag-Loonen HJ. et al. Association between postoperative muscle wasting and survival in older patients undergoing surgery for non-metastatic colorectal cancer. J Geriatr Oncol 2021; 12: 1052-1058 DOI: 10.1016/j.jgo.2021.04.004.
• 11 Heger P, Probst P, Wiskemann J. et al. A Systematic Review and Meta-analysis of Physical Exercise Prehabilitation in Major Abdominal Surgery (PROSPERO 2017 CRD42017080366). J Gastrointest Surg 2020; 24: 1375-1385 DOI: 10.1007/s11605-019-04287-w.
• 12 Assouline B, Cools E, Schorer R. et al. Preoperative Exercise Training to Prevent Postoperative Pulmonary Complications in Adults Undergoing Major Surgery. A Systematic Review and Meta-analysis with Trial Sequential Analysis. Ann Am Thorac Soc 2021; 18: 678-688 DOI: 10.1513/AnnalsATS.202002-183OC.
• 13 Van Rooijen S, Carli F, Dalton S. et al. Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: The first international randomized controlled trial for multimodal prehabilitation. BMC Cancer 2019; 19: 98 DOI: 10.1186/s12885-018-5232-6.
• 14 Trépanier M, Minnella EM, Paradis T. et al. Improved Disease-free Survival After Prehabilitation for Colorectal Cancer Surgery. Ann Surg 2019; 270: 493-501 DOI: 10.1097/SLA.0000000000003465.
• 15 Daniels SL, Lee MJ, George J. et al. Prehabilitation in elective abdominal cancer surgery in older patients: systematic review and meta-analysis. BJS Open 2020; 4: 1022-1041 DOI: 10.1002/bjs5.50347.
• 16 Waterland JL, McCourt O, Edbrooke L. et al. Efficacy of Prehabilitation Including Exercise on Postoperative Outcomes Following Abdominal Cancer Surgery: A Systematic Review and Meta-Analysis. Front Surg 2021; 8: 628848 DOI: 10.3389/fsurg.2021.628848.
• 17 Molenaar CJL, Van Rooijen SJ, Fokkenrood HJP. et al. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database Syst Rev 2022; (05) CD013259 DOI: 10.1002/14651858.CD013259.pub2.
• 18 Berkel AEM, Bongers BC, Kotte H. et al. Effects of Community-based Exercise Prehabilitation for Patients Scheduled for Colorectal Surgery With High Risk for Postoperative Complications: Results of a Randomized Clinical Trial. Ann Surg 2022; 275: e299-e306 DOI: 10.1097/SLA.0000000000004702.
• 19 Falz R, Bischoff C, Thieme R. et al. Effects and duration of exercise-based prehabilitation in surgical therapy of colon and rectal cancer: a systematic review and meta-analysis. J Cancer Res Clin Oncol 2022; 148: 2187-2213 DOI: 10.1007/s00432-022-04088-w.
• 20 McIsaac DI, Gill M, Boland L. et al. Prehabilitation in adult patients undergoing surgery: an umbrella review of systematic reviews. Br J Anaesth 2022; 128: 244-257 DOI: 10.1016/j.bja.2021.11.014.
• 21 Carli F, Charlebois P, Stein B. et al. Randomized clinical trial of prehabilitation in colorectal surgery. Br J Surg 2010; 97: 1187-1197 DOI: 10.1002/bjs.7102.