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Präkonditionierung vor viszeralonkologischen Operationen

Ein Paradigmenwechsel in der Viszeralchirurgie?

Preconditioning prior to visceral oncological surgery

A paradigm shift in visceral surgery?

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Zusammenfassung

Hintergrund

Postoperative Komplikationen können nach komplexen viszeralonkologischen Operationen zu erheblichen Beeinträchtigungen des Patienten und daraus resultierend zu einer prolongierten postoperativen stationären Verweildauer führen. Daher sollte die aktive Gestaltung der präoperativen Phase einen wichtigen Bestandteil der präoperativen/neoadjuvanten Therapie darstellen.

Ziel der Arbeit

Ziel der vorliegenden Arbeit ist eine kritische Darstellung aktueller Prähabilitationskonzepte sowie deren Anwendbarkeit und Entwicklungspotenzial in der Viszeralchirurgie.

Material und Methoden

Anhand einer selektiven Literaturübersicht werden aktuelle Studien und Konzepte vorgestellt und Therapiealgorithmen präsentiert.

Ergebnisse

Die vorliegenden Studien unterscheiden sich in Zielgrößen, Gestaltung und zeitlichem Rahmen der Intervention. Insgesamt zeigen die Studienergebnisse positive Effekte einer aktiven Steigerung der körperlichen Fitness in der präoperativen Phase in Bezug auf die Lebensqualität, Rekonvaleszenz und postoperative pulmonale Komplikationsrate.

Diskussion

Neben der Beurteilung des individuellen Komplikationsrisikos mittels Spiroergometrie kann durch ein gezieltes Ernährungs- und Aufbauprogramm die Leistungsfähigkeit vor viszeralchirurgischen Operationen gesteigert und somit Einfluss auf das postoperative Komplikationsrisiko genommen werden. Die Leistungsfähigkeit ist als modifizierbarer Risikofaktor zu verstehen, der auch in einem kurzen Zeitfenster präoperativ positiv beeinflusst werden kann. Die individuelle präoperative Versorgung optimiert die physische und psychische Verfassung der Patienten. Zur Sicherstellung der geforderten individuellen Versorgung müssen Ansätze geschaffen werden, die sich dezentral umsetzen lassen.

Abstract

Background

Postoperative complications after complex visceral oncological surgery can lead to substantial impairment of patients. In addition, preoperative physical performance and the severity of postoperative complications determine the long-term recovery process of physical function. Therefore, preconditioning in the preoperative period should be an important part of the preoperative/neoadjuvant treatment.

Objective

The aim of this article is a critical appraisal of current concepts of prehabilitation as well as their development potential and applicability in visceral surgery.

Material and methods

Based on a selective literature review, current studies and implemented concepts are presented and therapy algorithms are provided.

Results

This study differs in primary outcome, design and temporal framework of the intervention. The study results showed positive effects of an active increase in physical fitness in the preoperative period with respect to the quality of life, convalescence and postoperative pulmonary complication rate.

Discussion

In addition to the assessment of the individual risk of complications by means of spiroergometry, a targeted nutrition and exercise program can increase the individual performance level prior to visceral surgery and, thus, influence the postoperative risk of complications. The performance should be understood as a modifiable risk factor, which can also be positively influenced in the preoperative phase, even in a short time period. Individual preoperative care optimizes the physical and psychological situation of patients. To ensure the required individual care, approaches must be created and pursued, which can be implemented in a decentralized way.

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Authors and Affiliations

  1. Abteilung Sportmedizin, Prävention und Rehabilitation am Institut für Sportwissenschaft, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland

    D. Pfirrmann & P. Simon

  2. Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax‑ und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Liebigstr. 20, 04103, Leipzig, Deutschland

    M. Mehdorn, M. Hänsig &  I. Gockel MBA

  3. Klinik und Poliklinik für Anästhesiologie und Intensivmedizin (KAI), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland

    S. Stehr

  4. Klinik und Poliklinik für Gastroenterologie und Rheumatologie; Ernährungsteam, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland

    L. Selig

  5. Klinik und Poliklinik für Allgemein‑, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Leipzig, Deutschland

    A. Weimann

  6. Universitäres Krebszentrum Leipzig (UCCL), Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland

    M. Knödler & F. Lordick

  7. Abteilung für Medizinische Psychologie und Medizinische Soziologie, Sektion Psychosoziale Onkologie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland

    A. Mehnert

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  1. D. Pfirrmann
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Corresponding author

Correspondence to I. Gockel MBA.

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Interessenkonflikt

D. Pfirrmann, P. Simon, M. Mehdorn, M. Hänsig, S. Stehr, L. Selig, A. Weimann, M. Knödler, F. Lordick, A. Mehnert und I. Gockel geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Den Beitrag Spezialsituationen der Präkonditionierung und Prähabilitation in der onkologischen Viszeralchirurgie finden Sie online unter https://doi.org/10.1007/s00104-018-0708-0.

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Pfirrmann, D., Simon, P., Mehdorn, M. et al. Präkonditionierung vor viszeralonkologischen Operationen. Chirurg 89, 896–902 (2018). https://doi.org/10.1007/s00104-018-0709-z

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