Paradigm shift in gastrointestinal surgery−combating sarcopenia with prehabilitation:Multimodal review of clinical and scientific data

A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes.These included an increased risk of total complications,major complications,re-admissions,infections,severe infections,30 d mortality,longer hospital stay and increased hospitalization expenditures.A program to enhance recovery after surgery was meant to address these complications;however,compliance to the program since its introduction has been less than ideal.Over the last decade,the concept of prehabilitation,or"pre-surgery rehabilitation",has been discussed.The presurgical period represents a window of opportunity to boost and optimize the health of an individual,providing a compensatory"buffer"for the imminent reduction in physiological reserve postsurgery.Initial results have been promising.We review the literature to critically review the utility of prehabilitation,not just in the clinical realm,but also in the scientific realm,with a resource management point-of-view.

直肠癌根治术中的盆腔自主神经保护:30年变迁

全直肠系膜切除(TME)理念及微创技术(如腹腔镜结直肠手术和机器人手术)的出现大大提高直肠癌的外科疗效。然而,术后排尿功能和性功能障碍率仍然较高,从而给患者造成巨大的痛苦,同时也会给手术医生带来困扰。新辅助和辅助放疗应用的增多也带来了更多的功能问题。在本文中,我们对盆腔神经解剖的目前认识进行了评价,将盆腔神经分为肠系膜下动脉根部、侧盆壁及泌尿生殖器官周围等区域,探讨了在这些区域如何进行手术操作。同时,我们也讨论了过去30年不同手术方式(包括开腹、腹腔镜和机器人)的功能状况。