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Prehabilitation Prior to Major Cancer Surgery: Training for Surgery to Optimize Physiologic Reserve to Reduce Postoperative Complications

  • Cancer Anesthesia (B Riedel and V Gottumukkala, Section Editors)
  • Published:
Current Anesthesiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The aging, sedentary global population and associated increasing incidence of cancer calls for increasingly complex surgery. These patients are at particular risk of postoperative complications. This review will explore the redesign of the perioperative care pathway, with emphasis on preoperative risk stratification to identify modifiable risk, to implement risk mitigation strategies (e.g., prehabilitation), and to partner with patients to enhance recovery after surgery.

Recent Findings

In the last decade, there has been a growing body of literature surrounding prehabilitation. A number of these studies report a staggering halving of postoperative complications. This body of literature requires perioperative medicine clinicians to appraise and build on the robustness of the data and to consider pragmatic strategies toward implementation of what appears to be a cost-effective intervention.

Summary

A redesign of perioperative care pathways with early risk stratification and implementing risk mitigation strategies is essential to delivering on the value proposition of healthcare. Challenges include a redesign of funding models to deliver such services, engaging patients with relatively remote access to such services, and the cultural trends of sedentary lifestyles and perceived urgency to have immediate surgery at all costs.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Anaesthesia, Perioperative and Pain Medicine, Peter MacCallum Cancer Centre, Grattan St, Parkville, VIC, 3005, Australia

    Hilmy Ismail, Jamie Waterland & Bernhard Riedel

  2. Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia

    Hilmy Ismail & Bernhard Riedel

  3. Exercise Physiology, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia

    Prue Cormie

  4. Department of Hematology, Peter MacCallum Cancer Centre, Melbourne, Australia

    Kate Burbury

  5. Physiotherapy, Melbourne School of Health Sciences, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia

    Jamie Waterland & Linda Denehy

  6. Department of Allied Health, Peter MacCallum Cancer Centre, Melbourne, Australia

    Jamie Waterland & Linda Denehy

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  1. Hilmy Ismail
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  2. Prue Cormie
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  4. Jamie Waterland
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Correspondence to Hilmy Ismail.

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Hilmy Ismail declares that he has no conflict of interest.

Prue Cormie is a Director of Fit-4-Surgery Pty Ltd.

Kate Burbury declares that she has no conflict of interest.

Jamie Waterland declares that she has no conflict of interest.

Linda Denehy declares that she has no conflict of interest.

Bernhard Riedel declares that he has no conflict of interest.

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Ismail, H., Cormie, P., Burbury, K. et al. Prehabilitation Prior to Major Cancer Surgery: Training for Surgery to Optimize Physiologic Reserve to Reduce Postoperative Complications. Curr Anesthesiol Rep 8, 375–385 (2018). https://doi.org/10.1007/s40140-018-0300-7

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