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Critical appraisal on the impact of preoperative rehabilitation and outcomes after major abdominal and cardiothoracic surgery: A systematic review and meta-analysis

Published:September 20, 2019DOI:https://doi.org/10.1016/j.surg.2019.07.032

      Abstract

      Background

      There has been increasing interest in the prehabilitation of patients undergoing major abdominal surgery to improve perioperative outcomes. This systematic review and meta-analysis aims to evaluate and compare the current literature on prehabilitation in major abdominal surgery and cardiothoracic surgery

      Methods

      A systematic literature search was conducted for studies reporting prehabilitation in patients undergoing major abdominal and cardiothoracic surgery. Meta-analysis of postoperative outcomes (overall and major complications, pulmonary and cardiac complications, postoperative pneumonia, and length of hospital stay) was performed using random effects models.

      Results

      Five thousand nine hundred and twenty-one patients underwent prehabilitation in 61 studies, of which 35 studies (n = 3,402) were in major abdominal surgery and 26 studies were in cardiothoracic surgery (n = 2,519). Only 45 studies compared the impact of prehabilitation versus no prehabilitation on postoperative outcomes (abdominal, n = 26; cardiothoracic, n = 19). Quality of evidence for prehabilitation in major abdominal and cardiothoracic surgery appear equivalent. Patients receiving prehabilitation for major abdominal surgery have significantly lower rates of overall (n = 10, odds ratio: 0.61, confidence interval 95%: 0.43–0.86, P = .005), pulmonary (n = 15, odds ratio: 0.41, confidence interval 95%: 0.25–0.67, P < .001), and cardiac complications (n = 4, odds ratio: 0.46, confidence interval 95%: 0.22–0.96, P = .044). Sensitivity analysis including randomized controlled trials only did not alter the findings of this study.

      Conclusion

      Prehabilitation has the potential to improve surgical outcomes in patients undergoing major abdominal and cardiothoracic surgery. However, current evidence from randomized studies remains weak owing to variation in prehabilitation regimes, limiting the assessment of current postoperative outcomes.
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      References

        • Weiser T.G.
        • Regenbogen S.E.
        • Thompson K.D.
        • et al.
        An estimation of the global volume of surgery: a modelling strategy based on available data.
        Lancet. 2008; 372: 139-144
        • Rose J.
        • Weiser T.G.
        • Hider P.
        • et al.
        Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate.
        Lancet Glob Health. 2015; 3: S13-S20
        • Carli F.
        • Zavorsky G.S.
        Optimizing functional exercise capacity in the elderly surgical population.
        Curr Opin Clin Nutr Metab Care. 2005; 8: 23-32
        • Khuri S.F.
        • Henderson W.G.
        • DePalma R.G.
        • et al.
        Determinants of long-term survival after major surgery and the adverse effect of postoperative complications.
        Ann Surg. 2005; 242 (discussion 341-343): 326-341
        • Lawrence V.A.
        • Hazuda H.P.
        • Cornell J.E.
        • et al.
        Functional independence after major abdominal surgery in the elderly.
        J Am Coll Surg. 2004; 199: 762-772
        • Barberan-Garcia A.
        • Ubre M.
        • Roca J.
        • et al.
        Personalised prehabilitation in high-risk patients undergoing elective major abdominal surgery: A randomized blinded controlled trial.
        Ann Surg. 2018; 267: 50-56
        • Gillis C.
        • Li C.
        • Lee L.
        • et al.
        Prehabilitation versus rehabilitation: a randomized control trial in patients undergoing colorectal resection for cancer.
        Anesthesiology. 2014; 121: 937-947
        • Boshier P.R.
        • Heneghan R.
        • Markar S.R.
        • Baracos V.E.
        • Low D.E.
        Assessment of body composition and sarcopenia in patients with esophageal cancer: a systematic review and meta-analysis.
        Dis Esophagus. 2018; 31
        • Kamarajah S.K.
        • Bundred J.
        • Tan B.H.L.
        Body composition assessment and sarcopenia in patients with gastric cancer: a systematic review and meta-analysis.
        Gastric Cancer. 2019; 22: 10-22
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration.
        BMJ. 2009; 339: b2700
        • Clavien P.A.
        • Barkun J.
        • de Oliveira M.L.
        • et al.
        The Clavien-Dindo classification of surgical complications: five-year experience.
        Ann Surg. 2009; 250: 187-196
        • Lo C.K.
        • Mertz D.
        • Loeb M.
        Newcastle-Ottawa Scale: comparing reviewers' to authors' assessments.
        BMC Med Res Methodol. 2014; 14: 45
        • Stang A.
        Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.
        Eur J Epidemiol. 2010; 25: 603-605
        • Stroup D.F.
        • Berlin J.A.
        • Morton S.C.
        • et al.
        Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.
        JAMA. 2000; 283: 2008-2012
        • Gumedze F.N.
        • Jackson D.
        A random effects variance shift model for detecting and accommodating outliers in meta-analysis.
        BMC Med Res Methodol. 2011; 11: 19
        • Kamarajah S.K.
        • Chapman S.J.
        • Glasbey J.
        • et al.
        Systematic review of the stage of innovation of biological mesh for complex or contaminated abdominal wall closure.
        BJS Open. 2018; 2: 371-380
        • Kamarajah S.K.
        • Sonnenday C.J.
        • Cho C.S.
        • et al.
        Association of adjuvant radiotherapy with survival after margin-negative resection of pancreatic ductal adenocarcinoma: A propensity-matched National Cancer Database (NCDB) analysis.
        Ann Surg. 2019; (Available from:) (Accessed May 18, 2019)
        • Kamarajah S.K.
        • Sutandi N.
        • Robinson S.R.
        • et al.
        Robotic versus conventional laparoscopic distal pancreatic resection: a systematic review and meta-analysis.
        HPB (Oxford). 2019; (Available from:) (Accessed May 18, 2019)
        • Dronkers J.
        • Veldman A.
        • Hoberg E.
        • van der Waal C.
        • van Meeteren N.
        Prevention of pulmonary complications after upper abdominal surgery by preoperative intensive inspiratory muscle training: a randomized controlled pilot study.
        Clin Rehabil. 2008; 22: 134-142
        • Barakat H.M.
        • Shahin Y.
        • Barnes R.
        • et al.
        Supervised exercise program improves aerobic fitness in patients awaiting abdominal aortic aneurysm repair.
        Ann Vasc Surg. 2014; 28: 74-79
        • Tew G.A.
        • Batterham A.M.
        • Colling K.
        • et al.
        Randomized feasibility trial of high-intensity interval training before elective abdominal aortic aneurysm repair.
        Br J Surg. 2017; 104: 1791-1801
        • Jensen B.T.
        • Petersen A.K.
        • Jensen J.B.
        • Laustsen S.
        • Borre M.
        Efficacy of a multiprofessional rehabilitation programme in radical cystectomy pathways: a prospective randomized controlled trial.
        Scand J Urol. 2015; 49: 133-141
        • Fagevik Olsen M.
        • Hahn I.
        • Nordgren S.
        • Lonroth H.
        • Lundholm K.
        Randomized controlled trial of prophylactic chest physiotherapy in major abdominal surgery.
        Br J Surg. 1997; 84: 1535-1538
        • Kulkarni S.R.
        • Fletcher E.
        • McConnell A.K.
        • Poskitt K.R.
        • Whyman M.R.
        Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery - a randomised pilot study.
        Ann R Coll Surg Engl. 2010; 92: 700-707
        • Boden I.
        • Skinner E.H.
        • Browning L.
        • et al.
        Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial.
        BMJ. 2018; 360: j5916
        • Kaibori M.
        • Ishizaki M.
        • Matsui K.
        • et al.
        Perioperative exercise for chronic liver injury patients with hepatocellular carcinoma undergoing hepatectomy.
        Am J Surg. 2013; 206: 202-209
        • Dronkers J.J.
        • Lamberts H.
        • Reutelingsperger I.M.
        • et al.
        Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: a randomized controlled pilot study.
        Clin Rehabil. 2010; 24: 614-622
        • Dronkers J.J.
        • Chorus A.M.
        • van Meeteren N.L.
        • Hopman-Rock M.
        The association of pre-operative physical fitness and physical activity with outcome after scheduled major abdominal surgery.
        Anaesthesia. 2013; 68: 67-73
        • Li C.
        • Carli F.
        • Lee L.
        • et al.
        Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study.
        Surg Endosc. 2013; 27: 1072-1082
        • Minnella E.M.
        • Awasthi R.
        • Gillis C.
        • et al.
        Patients with poor baseline walking capacity are most likely to improve their functional status with multimodal prehabilitation.
        Surgery. 2016; 160: 1070-1079
        • Minnella E.M.
        • Bousquet-Dion G.
        • Awasthi R.
        • Scheede-Bergdahl C.
        • Carli F.
        Multimodal prehabilitation improves functional capacity before and after colorectal surgery for cancer: a five-year research experience.
        Acta Oncol. 2017; 56: 295-300
        • Bousquet-Dion G.
        • Awasthi R.
        • Loiselle S.E.
        • et al.
        Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial.
        Acta Oncol. 2018; 57: 849-859
        • Kim D.J.
        • Mayo N.E.
        • Carli F.
        • Montgomery D.L.
        • Zavorsky G.S.
        Responsive measures to prehabilitation in patients undergoing bowel resection surgery.
        Tohoku J Exp Med. 2009; 217: 109-115
        • Carli F.
        • Charlebois P.
        • Stein B.
        • et al.
        Randomized clinical trial of prehabilitation in colorectal surgery.
        Br J Surg. 2010; 97: 1187-1197
        • Howard R.
        • Yin Y.S.
        • McCandless L.
        • Wang S.
        • Englesbe M.
        • Machado-Aranda D.
        Taking control of your surgery: Impact of a prehabilitation program on major abdominal surgery.
        J Am Coll Surg. 2019; 228: 72-80
        • Timmerman H.
        • de Groot J.F.
        • Hulzebos H.J.
        • de Knikker R.
        • Kerkkamp H.E.
        • van Meeteren N.L.
        Feasibility and preliminary effectiveness of preoperative therapeutic exercise in patients with cancer: a pragmatic study.
        Physiother Theory Pract. 2011; 27: 117-124
        • Barbalho-Moulim M.C.
        • Miguel G.P.
        • Forti E.M.
        • Campos-Fdo A.
        • Costa D.
        Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion.
        Clinics (Sao Paulo). 2011; 66: 1721-1727
        • Llorens J.
        • Rovira L.
        • Ballester M.
        • et al.
        Preoperative inspiratory muscular training to prevent postoperative hypoxemia in morbidly obese patients undergoing laparoscopic bariatric surgery. A randomized clinical trial.
        Obes Surg. 2015; 25: 1003-1009
        • Roukema J.A.
        • Carol E.J.
        • Prins J.G.
        The prevention of pulmonary complications after upper abdominal surgery in patients with noncompromised pulmonary status.
        Arch Surg. 1988; 123: 30-34
        • Soares S.M.
        • Nucci L.B.
        • da Silva M.M.
        • et al.
        Pulmonary function and physical performance outcomes with preoperative physical therapy in upper abdominal surgery: a randomized controlled trial.
        Clin Rehabil. 2013; 27: 616-627
        • Cho H.
        • Yoshikawa T.
        • Oba M.S.
        • et al.
        Matched pair analysis to examine the effects of a planned preoperative exercise program in early gastric cancer patients with metabolic syndrome to reduce operative risk: the Adjuvant Exercise for General Elective Surgery (AEGES) study group.
        Ann Surg Oncol. 2014; 21: 2044-2050
        • Abdelaal G.A.E.S.S.
        • Abdelsamie M.
        • Labeeb A.
        Effect of preoperative physical and respiratory therapy on postoperative pulmonary functions and complications after laparoscopic upper abdominal surgery in obese patients.
        Egyptian Journal of Chest Diseases and Tuberculosis. 2017; 66: 735-738
        • Kale P.M.M.V.
        • Mohite R.V.
        • Chendake M.B.
        • Gholap M.C.
        The effectiveness of pre-operative deep breathing exercise on post-operative patients of abdominal surgery.
        Asian J Pharmaceutical and Clinical Research. 2017; 10: 157-160
        • Agrelli T.F.
        • de Carvalho Ramos M.
        • Guglielminetti R.
        • Silva A.A.
        • Crema E.
        Preoperative ambulatory inspiratory muscle training in patients undergoing esophagectomy. A pilot study.
        Int Surg. 2012; 97: 198-202
        • Dettling D.S.
        • van der Schaaf M.
        • Blom R.L.
        • Nollet F.
        • Busch O.R.
        • van Berge Henegouwen M.I.
        Feasibility and effectiveness of pre-operative inspiratory muscle training in patients undergoing oesophagectomy: a pilot study.
        Physiother Res Int. 2013; 18: 16-26
        • van Adrichem E.J.
        • Meulenbroek R.L.
        • Plukker J.T.
        • Groen H.
        • van Weert E.
        Comparison of two preoperative inspiratory muscle training programs to prevent pulmonary complications in patients undergoing esophagectomy: a randomized controlled pilot study.
        Ann Surg Oncol. 2014; 21: 2353-2360
        • Agrelli T.F.
        • Borges M.C.
        • Cunha F.M.R.D.
        • Silva E.M.C.D.
        • Terra Junior J.A.
        • Crema E.
        Combination of preoperative pulmonary and nutritional preparation for esophagectomy.
        Acta Cir Bras. 2018; 33: 67-74
        • Valkenet K.
        • Trappenburg J.C.A.
        • Ruurda J.P.
        • et al.
        Multicentre randomized clinical trial of inspiratory muscle training versus usual care before surgery for oesophageal cancer.
        Br J Surg. 2018; 105: 502-511
        • Guinan E.M.
        • Forde C.
        • O'Neill L.
        • et al.
        Effect of preoperative inspiratory muscle training on physical functioning following esophagectomy.
        Dis Esophagus. 2019; 32
        • Minnella E.M.
        • Awasthi R.
        • Loiselle S.E.
        • Agnihotram R.V.
        • Ferri L.E.
        • Carli F.
        Effect of exercise and nutrition prehabilitation on functional capacity in esophagogastric cancer surgery: A randomized clinical trial.
        JAMA Surg. 2018; 153: 1081-1089
        • Hulzebos E.H.
        • van Meeteren N.L.
        • van den Buijs B.J.
        • de Bie R.A.
        • Brutel de la Riviere A.
        • Helders P.J.
        Feasibility of preoperative inspiratory muscle training in patients undergoing coronary artery bypass surgery with a high risk of postoperative pulmonary complications: a randomized controlled pilot study.
        Clin Rehabil. 2006; 20: 949-959
        • Yanez-Brage I.
        • Pita-Fernandez S.
        • Juffe-Stein A.
        • Martinez-Gonzalez U.
        • Pertega-Diaz S.
        • Mauleon-Garcia A.
        Respiratory physiotherapy and incidence of pulmonary complications in off-pump coronary artery bypass graft surgery: an observational follow-up study.
        BMC Pulm Med. 2009; 9: 36
        • Sawatzky J.A.
        • Kehler D.S.
        • Ready A.E.
        • et al.
        Prehabilitation program for elective coronary artery bypass graft surgery patients: a pilot randomized controlled study.
        Clin Rehabil. 2014; 28: 648-657
        • Sobrinho M.T.
        • Guirado G.N.
        • Silva M.A.
        Preoperative therapy restores ventilatory parameters and reduces length of stay in patients undergoing myocardial revascularization.
        Rev Bras Cir Cardiovasc. 2014; 29: 221-228
        • Shakouri S.K.
        • Salekzamani Y.
        • Taghizadieh A.
        • et al.
        Effect of respiratory rehabilitation before open cardiac surgery on respiratory function: a randomized clinical trial.
        J Cardiovasc Thorac Res. 2015; 7: 13-17
        • Valkenet K.
        • Trappenburg J.C.A.
        • Hulzebos E.H.
        • van Meeteren N.L.U.
        • Backx F.J.G.
        Effects of a pre-operative home-based inspiratory muscle training programme on perceived health-related quality of life in patients undergoing coronary artery bypass graft surgery.
        Physiotherapy. 2017; 103: 276-282
        • Hadj A.
        • Esmore D.
        • Rowland M.
        • et al.
        Pre-operative preparation for cardiac surgery utilising a combination of metabolic, physical and mental therapy.
        Heart Lung Circ. 2006; 15: 172-181
        • Ferreira P.E.
        • Rodrigues A.J.
        • Evora P.R.
        Effects of an inspiratory muscle rehabilitation program in the postoperative period of cardiac surgery.
        Arq Bras Cardiol. 2009; 92: 275-282
        • Rosenfeldt F.
        • Braun L.
        • Spitzer O.
        • et al.
        Physical conditioning and mental stress reduction--a randomised trial in patients undergoing cardiac surgery.
        BMC Complement Altern Med. 2011; 11: 20
        • Kalogianni A.
        • Almpani P.
        • Vastardis L.
        • Baltopoulos G.
        • Charitos C.
        • Brokalaki H.
        Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery?.
        Eur J Cardiovasc Nurs. 2016; 15: 447-458
        • Waite I.
        • Deshpande R.
        • Baghai M.
        • Massey T.
        • Wendler O.
        • Greenwood S.
        Home-based preoperative rehabilitation (prehab) to improve physical function and reduce hospital length of stay for frail patients undergoing coronary artery bypass graft and valve surgery.
        J Cardiothorac Surg. 2017; 12: 91
        • Vagvolgyi A.
        • Rozgonyi Z.
        • Kerti M.
        • Agathou G.
        • Vadasz P.
        • Varga J.
        Effectiveness of pulmonary rehabilitation and correlations in between functional parameters, extent of thoracic surgery and severity of post-operative complications: randomized clinical trial.
        J Thorac Dis. 2018; 10: 3519-3531
        • Yusen R.D.
        • Lefrak S.S.
        • Gierada D.S.
        • et al.
        A prospective evaluation of lung volume reduction surgery in 200 consecutive patients.
        Chest. 2003; 123: 1026-1037
        • Jones L.W.
        • Peddle C.J.
        • Eves N.D.
        • et al.
        Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions.
        Cancer. 2007; 110: 590-598
        • Matzi V.
        • Lindenmann J.
        • Muench A.
        • et al.
        The impact of preoperative micronutrient supplementation in lung surgery. A prospective randomized trial of oral supplementation of combined alpha-ketoglutaric acid and 5-hydroxymethylfurfural.
        Eur J Cardiothorac Surg. 2007; 32: 776-782
        • Bobbio A.
        • Chetta A.
        • Ampollini L.
        • et al.
        Preoperative pulmonary rehabilitation in patients undergoing lung resection for non-small cell lung cancer.
        Eur J Cardiothorac Surg. 2008; 33: 95-98
        • Benzo R.
        • Wigle D.
        • Novotny P.
        • et al.
        Preoperative pulmonary rehabilitation before lung cancer resection: results from two randomized studies.
        Lung Cancer. 2011; 74: 441-445
        • Pehlivan E.
        • Turna A.
        • Gurses A.
        • Gurses H.N.
        The effects of preoperative short-term intense physical therapy in lung cancer patients: a randomized controlled trial.
        Ann Thorac Cardiovasc Surg. 2011; 17: 461-468
        • Morano M.T.
        • Araujo A.S.
        • Nascimento F.B.
        • et al.
        Preoperative pulmonary rehabilitation versus chest physical therapy in patients undergoing lung cancer resection: a pilot randomized controlled trial.
        Arch Phys Med Rehabil. 2013; 94: 53-58
        • Stefanelli F.
        • Meoli I.
        • Cobuccio R.
        • et al.
        High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy.
        Eur J Cardiothorac Surg. 2013; 44: e260-e265
        • Chesterfield-Thomas G.
        • Goldsmith I.
        Impact of preoperative pulmonary rehabilitation on the Thoracoscore of patients undergoing lung resection.
        Interact Cardiovasc Thorac Surg. 2016; 23: 729-732
        • Lai Y.
        • Huang J.
        • Yang M.
        • Su J.
        • Liu J.
        • Che G.
        Seven-day intensive preoperative rehabilitation for elderly patients with lung cancer: a randomized controlled trial.
        J Surg Res. 2017; 209: 30-36
        • Licker M.
        • Karenovics W.
        • Diaper J.
        • et al.
        Short-Term preoperative high-intensity interval training in patients awaiting lung cancer surgery: A randomized controlled trial.
        J Thorac Oncol. 2017; 12: 323-333
        • Saito H.
        • Hatakeyama K.
        • Konno H.
        • Matsunaga T.
        • Shimada Y.
        • Minamiya Y.
        Impact of pulmonary rehabilitation on postoperative complications in patients with lung cancer and chronic obstructive pulmonary disease.
        Thorac Cancer. 2017; 8: 451-460
        • Sebio Garcia R.
        • Yanez-Brage M.I.
        • Gimenez Moolhuyzen E.
        • Salorio Riobo M.
        • Lista Paz A.
        • Borro Mate J.M.
        Preoperative exercise training prevents functional decline after lung resection surgery: a randomized, single-blind controlled trial.
        Clin Rehabil. 2017; 31: 1057-1067
        • Mujovic N.
        • Mujovic N.
        • Subotic D.
        • et al.
        Preoperative pulmonary rehabilitation in patients with non-small cell lung cancer and chronic obstructive pulmonary disease.
        Arch Med Sci. 2014; 10: 68-75
        • Cabilan C.J.
        • Hines S.
        • Munday J.
        The effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review.
        JBI Database System Rev Implement Rep. 2015; 13: 146-187
        • Kawamura T.
        • Makuuchi R.
        • Tokunaga M.
        • et al.
        Long-term outcomes of gastric cancer patients with preoperative sarcopenia.
        Ann Surg Oncol. 2018; 25: 1625-1632
        • Braga M.
        • Gianotti L.
        • Vignali A.
        • et al.
        Preoperative oral arginine and n-3 fatty acid supplementation improves the immunometabolic host response and outcome after colorectal resection for cancer.
        Surgery. 2002; 132: 805-814
        • Burden S.T.
        • Hill J.
        • Shaffer J.L.
        • Campbell M.
        • Todd C.
        An unblinded randomised controlled trial of preoperative oral supplements in colorectal cancer patients.
        J Hum Nutr Diet. 2011; 24: 441-448
        • Burden S.T.
        • Gibson D.J.
        • Lal S.
        • et al.
        Pre-operative oral nutritional supplementation with dietary advice versus dietary advice alone in weight-losing patients with colorectal cancer: single-blind randomized controlled trial.
        J Cachexia Sarcopenia Muscle. 2017; 8: 437-446
        • Gianotti L.
        • Braga M.
        • Nespoli L.
        • Radaelli G.
        • Beneduce A.
        • Di Carlo V.
        A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer.
        Gastroenterology. 2002; 122: 1763-1770
        • Cho H.
        • Tsuburaya A.
        • Sakamoto J.
        • et al.
        and the Adjuvant Exercise for General Elective Surgery (AEGES) Study Group. A randomized phase II trial of preoperative exercise to reduce operative risk in gastric cancer patients with metabolic syndrome: adjuvant exercise for general elective surgery (AEGES) study group.
        Jpn J Clin Oncol. 2008; 38: 71-73
        • Allen S.
        • Brown V.
        • Prabhu P.
        • et al.
        A randomised controlled trial to assess whether prehabilitation improves fitness in patients undergoing neoadjuvant treatment prior to oesophagogastric cancer surgery: study protocol.
        BMJ Open. 2018; 8e023190
        • West M.A.
        • Wischmeyer P.E.
        • Grocott M.P.W.
        Prehabilitation and nutritional support to improve perioperative outcomes.
        Curr Anesthesiol Rep. 2017; 7: 340-349
        • McIsaac D.I.
        • Saunders C.
        • Hladkowicz E.
        • et al.
        PREHAB study: a protocol for a prospective randomised clinical trial of exercise therapy for people living with frailty having cancer surgery.
        BMJ Open. 2018; 8e022057
        • Henry C.J.
        Basal metabolic rate studies in humans: measurement and development of new equations.
        Public Health Nutr. 2005; 8: 1133-1152
        • Elia M.
        • Wood S.
        • Khan K.
        • Pullicino E.
        Ketone body metabolism in lean male adults during short-term starvation, with particular reference to forearm muscle metabolism.
        Clin Sci (Lond). 1990; 78: 579-584
        • Ljungqvist O.
        • Scott M.
        • Fearon K.C.
        Enhanced recovery after surgery: A review.
        JAMA Surg. 2017; 152: 292-298
        • Ding J.
        • Sun B.
        • Song P.
        • et al.
        The application of enhanced recovery after surgery (ERAS)/fast-track surgery in gastrectomy for gastric cancer: a systematic review and meta-analysis.
        Oncotarget. 2017; 8: 75699-75711
        • Mortensen K.
        • Nilsson M.
        • Slim K.
        • et al.
        Consensus guidelines for enhanced recovery after gastrectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations.
        Br J Surg. 2014; 101: 1209-1229
        • Sahoo M.R.
        • Gowda M.S.
        • Kumar A.T.
        Early rehabilitation after surgery program versus conventional care during perioperative period in patients undergoing laparoscopic assisted total gastrectomy.
        J Minim Access Surg. 2014; 10: 132-138
        • Valkenet K.
        • Trappenburg J.C.
        • Gosselink R.
        • et al.
        Preoperative inspiratory muscle training to prevent postoperative pulmonary complications in patients undergoing esophageal resection (PREPARE study): study protocol for a randomized controlled trial.
        Trials. 2014; 15: 144
        • Abdullah H.R.
        • Lien V.P.
        • Ong H.K.
        • et al.
        Protocol for a single-centre, randomised controlled study of a preoperative rehabilitation bundle in the frail and elderly undergoing abdominal surgery.
        BMJ Open. 2017; 7e016815

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