PMID- 30193337
OWN - NLM
STAT- MEDLINE
DCOM- 20191003
LR  - 20200309
IS  - 2168-6262 (Electronic)
IS  - 2168-6254 (Print)
IS  - 2168-6254 (Linking)
VI  - 153
IP  - 12
DP  - 2018 Dec 1
TI  - Effect of Exercise and Nutrition Prehabilitation on Functional Capacity in 
      Esophagogastric Cancer Surgery: A Randomized Clinical Trial.
PG  - 1081-1089
LID - 10.1001/jamasurg.2018.1645 [doi]
AB  - IMPORTANCE: Preserving functional capacity is a key element in the care continuum 
      for patients with esophagogastric cancer. Prehabilitation, a preoperative 
      conditioning intervention aiming to optimize physical status, has not been tested 
      in upper gastrointestinal surgery to date. OBJECTIVE: To investigate whether 
      prehabilitation is effective in improving functional status in patients 
      undergoing esophagogastric cancer resection. DESIGN, SETTING, AND PARTICIPANTS: A 
      randomized clinical trial (available-case analysis based on completed 
      assessments) was conducted at McGill University Health Centre (Montreal, Quebec, 
      Canada) comparing prehabilitation with a control group. Intervention consisted of 
      preoperative exercise and nutrition optimization. Participants were adults 
      awaiting elective esophagogastric resection for cancer. The study dates were 
      February 13, 2013, to February 10, 2017. MAIN OUTCOMES AND MEASURES: The primary 
      outcome was change in functional capacity, measured with absolute change in 
      6-minute walk distance (6MWD). Preoperative (end of the prehabilitation period) 
      and postoperative (from 4 to 8 weeks after surgery) data were compared between 
      groups. RESULTS: Sixty-eight patients were randomized, and 51 were included in 
      the primary analysis. The control group were a mean (SD) age, 68.0 (11.6) years 
      and 20 (80%) men. Patients in the prehabilitation group were a mean (SD) age, 
      67.3 (7.4) years and 18 (69%) men. Compared with the control group, the 
      prehabilitation group had improved functional capacity both before surgery (mean 
      [SD] 6MWD change, 36.9 [51.4] vs -22.8 [52.5] m; P < .001) and after surgery 
      (mean [SD] 6MWD change, 15.4 [65.6] vs -81.8 [87.0] m; P < .001). CONCLUSIONS AND 
      RELEVANCE: Prehabilitation improves perioperative functional capacity in 
      esophagogastric surgery. Keeping patients from physical and nutritional status 
      decline could have a significant effect on the cancer care continuum. TRIAL 
      REGISTRATION: ClinicalTrials.gov Identifier: NCT01666158.
FAU - Minnella, Enrico M
AU  - Minnella EM
AD  - Department of Anesthesia, McGill University Health Centre, Montreal General 
      Hospital, Montreal, Quebec, Canada.
FAU - Awasthi, Rashami
AU  - Awasthi R
AD  - Department of Anesthesia, McGill University Health Centre, Montreal General 
      Hospital, Montreal, Quebec, Canada.
FAU - Loiselle, Sarah-Eve
AU  - Loiselle SE
AD  - Department of Anesthesia, McGill University Health Centre, Montreal General 
      Hospital, Montreal, Quebec, Canada.
FAU - Agnihotram, Ramanakumar V
AU  - Agnihotram RV
AD  - Research Institute, McGill University Health Centre, Glen Site, Montreal, Quebec, 
      Canada.
FAU - Ferri, Lorenzo E
AU  - Ferri LE
AD  - Division of Thoracic Surgery, McGill University Health Centre, Montreal General 
      Hospital, Montreal, Quebec, Canada.
FAU - Carli, Francesco
AU  - Carli F
AD  - Department of Anesthesia, McGill University Health Centre, Montreal General 
      Hospital, Montreal, Quebec, Canada.
LA  - eng
SI  - ClinicalTrials.gov/NCT01666158
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JAMA Surg
JT  - JAMA surgery
JID - 101589553
SB  - IM
CIN - JAMA Surg. 2018 Dec 1;153(12):1089. PMID: 30193332
CIN - JAMA Surg. 2019 May 1;154(5):463. PMID: 30725074
CIN - JAMA Surg. 2019 May 1;154(5):463-464. PMID: 30725090
MH  - Aged
MH  - Esophageal Neoplasms/physiopathology/*rehabilitation
MH  - Exercise/*physiology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Nutritional Status/*physiology
MH  - Preoperative Care/*rehabilitation
MH  - Stomach Neoplasms/physiopathology/*rehabilitation
MH  - Walking/physiology
PMC - PMC6583009
COIS- Conflict of Interest Disclosures: None reported.
EDAT- 2018/09/08 06:00
MHDA- 2019/10/08 06:00
PMCR- 2019/09/05
CRDT- 2018/09/08 06:00
PHST- 2018/09/08 06:00 [pubmed]
PHST- 2019/10/08 06:00 [medline]
PHST- 2018/09/08 06:00 [entrez]
PHST- 2019/09/05 00:00 [pmc-release]
AID - 2698681 [pii]
AID - soi180029 [pii]
AID - 10.1001/jamasurg.2018.1645 [doi]
PST - ppublish
SO  - JAMA Surg. 2018 Dec 1;153(12):1081-1089. doi: 10.1001/jamasurg.2018.1645.