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Role of prehabilitation following major uro-oncologic surgery: a narrative review

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World Journal of Urology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 01 September 2022

A Letter to the Editor to this article was published on 09 April 2021

Abstract

Purpose

Functional status and physical independence play a key role in terms of quality of life, access to treatment, and continuity of care. Surgery, a central component of cancer treatments, leads to detrimental effects on functional capacity, which can be peculiarly relevant in vulnerable patients undergoing major procedures. Prehabilitation is a multidisciplinary intervention that uses the preoperative period to prevent or attenuate treatment-related functional decline and its subsequent consequences. This paper narratively reviews the rationale and the evidence of prehabilitation for uro-oncologic surgery.

Methods

A narrative review was conducted in August 2020, aiming to: (1) identify and discuss the impact of modifiable determinants of postoperative outcomes in urology and (2) review randomized controlled trials (RCT) exploring the role of preoperative exercise, nutrition, and psychological interventions in uro-oncologic surgery.

Results

Eight RCTs on preoperative conditioning interventions met the inclusion criteria, focusing on radical cystectomy for bladder cancer (RC) and radical prostatectomy for prostate cancer (RP). There is strong evidence that poor physical, nutritional and psychosocial status negatively impacts on surgical outcomes. Single modality interventions, such as preoperative exercise or nutrition alone, had no effect on ‘traditional’ surgical outcomes as length of stay or complication. However, multimodal approaches targeting postoperative functional status have shown to be effective and safe.

Conclusion

There is initial evidence on the effectiveness and safety of multimodal prehabilitation in preserving functional capacity following RC and RP. However, to date, outcomes such as complications and length of stay seem to be not affected by prehabilitation.

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Authors and Affiliations

  1. Department of Anesthesia, McGill University Health Centre, Montreal, QC, Canada

    Enrico Maria Minnella & Francesco Carli

  2. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy

    Enrico Maria Minnella

  3. Department of Urology, McGill University Health Centre, Montreal, QC, Canada

    Wassim Kassouf

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  1. Enrico Maria Minnella
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EMM was involved in manuscript writing/editing and data analysis. FC was involved in manuscript editing and data analysis. WK was involved in project development, data analysis, and manuscript editing.

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Minnella, E.M., Carli, F. & Kassouf, W. Role of prehabilitation following major uro-oncologic surgery: a narrative review. World J Urol 40, 1289–1298 (2022). https://doi.org/10.1007/s00345-020-03505-4

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