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. 2022 Mar;48(3):657-665.
doi: 10.1016/j.ejso.2021.10.006. Epub 2021 Oct 20.

Prehabilitation to improve postoperative outcomes in patients with peritoneal carcinomatosis undergoing hyperthermic intraperitoneal chemotherapy (HIPEC): A scoping review

D Strijker  1 , W J H J Meijerink  2 , A J A Bremers  3 , P de Reuver  3 , C J H M van Laarhoven  3 , B van den Heuvel  2
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Free article

Prehabilitation to improve postoperative outcomes in patients with peritoneal carcinomatosis undergoing hyperthermic intraperitoneal chemotherapy (HIPEC): A scoping review

D Strijker et al. Eur J Surg Oncol. 2022 Mar.
Free article

Abstract

Background: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) leads to increased survival rates in patients with peritoneal carcinomatosis, but is associated with considerable morbidity and mortality rates. Prehabilitation, a process to optimize a patient's preoperative functional capacity, has a positive impact on recovery after colorectal surgery. The impact of prehabilitation in patients undergoing HIPEC is scarcely investigated. This scoping review and narrative synthesis aims to summarize and evaluate what is currently reported about the effect of prehabilitation on postoperative outcomes after HIPEC.

Methods: A literature search of studies reporting on the effect of prehabilitation on outcomes after HIPEC was performed (August 2020). Study characteristics, patient demographics, composition of prehabilitation programs, and reported outcomes used to quantify the effect of prehabilitation were recorded.

Results: The literature search did not yield any studies on the effect of prehabilitation programs on outcomes after HIPEC. As an alternative, studies identifying modifiable risk factors for poor postoperative outcomes after HIPEC that can be targeted by prehabilitation were reviewed to evaluate starting points for prehabilitation. Fourteen studies identify the following preoperative factors: poor nutritional status, poor performance status, low health related quality of life and an history of smoking.

Conclusion: No research has been published on the effect of prehabilitation prior to HIPEC. This review demonstrates that preoperative modifiable risk factors for outcomes in patients undergoing HIPEC are multifactorial. A multimodal prehabilitation program prior to HIPEC, including nutritional support, psychical exercise, psychological support and smoking cessation, might therefore be a promising approach to improve postoperative outcomes.

Keywords: Hyperthermic intraperitoneal chemotherapy; Length of stay; Postoperative complication; Postoperative outcome; Prehabilitation; Preoperative risk factor.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Comment in

  • Would you ever run a marathon unprepared?
    Flaris AN, Glehen O, Passot G. Flaris AN, et al. Eur J Surg Oncol. 2022 Feb;48(2):307-308. doi: 10.1016/j.ejso.2021.10.014. Epub 2021 Oct 21. Eur J Surg Oncol. 2022. PMID: 34702590 No abstract available.

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