胃肠肿瘤患者的术前预康复

Prehabilitation for gastrointestinal cancer patients

胃肠肿瘤及针对性治疗(放化疗、手术)可以造成患者机体功能状态下降,并对生活质量、临床结局和治疗过程产生负面影响。其中心理困扰会给患者身心状态造成严重的伤害,常会经历焦虑、抑郁、自卑以及对复发和死亡的恐惧。癌症预康复是指肿瘤确诊到实施针对性治疗期间,进行的心理、生理和营养等方面评估、病情判断,并进行针对性的干预,改善患者的健康状况及功能能力,减少肿瘤、化放疗及手术等所带来的危害和严重程度。多模式术前预康复包括术前有计划、结构性、可重复、目标明确的综合体能锻炼、营养支持治疗和减轻焦虑抑郁状态的系列干预措施,已经成为ERAS路径管理最重要的举措之一,能够术前提高患者的功能状态、更好地应对手术应激、改善患者临床结局。但是胃肠道肿瘤术前预康复仍存在一些问题,包括最佳体能训练方案、干预的时机和方式、如何提高依从性、功能能力检测方法以及预康复成本效益等。因此,需要更多高级别循证医学证据来评估术前预康复临床应用的真实价值。

Gastrointestinal cancer and related treatments(surgery and chemoradiotherapy)are associated with declined functional status(FS)that has impact on quality of life,clinical outcome and continuum of care.Psychological distress drives an impressive burden of physiological and psychiatric conditions in oncologic care.Cancer patients often experience anxiety,depression,low self-esteem and fears of recurrence and death.Cancer prehabilitation is a process from cancer diagnosis to the beginning of treatment,which includes psychological,physical and nutritional assessments for a baseline functional level,identification of comorbidity,and targeted interventions that improve patient's health and functional capacity to reduce the incidence and the severity of current and future impairments with cancer,chemoradiotherapy and surgery.Multimodal prehabilitation program encompasses a series of planned,structured,repeatable and purposive interventions including comprehensive physical exercise,nutritional therapy,and relieving anxiety and depression,which integrates into best perioperative management ERAS pathway and aims at using the preoperative period to prevent or attenuate the surgery-related functional decline,to cope with surgical stress and to improve the consequences.However,a number of questions remain in regards to prehabilitation in gastrointestinal cancer surgery,which consists of the optimal makeup of training programs,the timing and approach of the intervention,how to improve compliance,how to measure functional capacity,and how to make cost-effective analysis.Therefore,more high-level evidence-based studies are expected to evaluate the value of implementation of prehabilitation into standard practice.