194. THE IMPACT OF PREHABILITATION IN UPPER GASTROINTESTINAL (GI) CANCER UNDERWENT MAJOR SURGERY

Abstract

Abstract Major upper gastrointestinal (GI) surgery always poses unique perioperative challenges and high post-surgical complications. Prehabilitation encompasses of exercise, nutrition and medical optimization prior to surgery. There is an emerging evidence to show prehabilitation plays a significant role in reducing morbidity and mortality associated with major upper GI surgery by improving patient’s functional status. Its role in improving postoperative outcomes such as length of stay (LOS) is less established. An interventional study conducted among oesophageal and gastric cancer patients who undergone oesophagectomy and gastrectomy surgery. All the preoperative patients are assessed by dietician and nutrition therapy will be intiated based on ESPEN guideline. A standard set of physical and breathing exercise are adopted. Study characteristics, ECOG status, handgrip, peak flow meter and spirometry are obtained. Primary outcome is impact of prehabilitation on functional capacity. Secondary outcomes include post-operative length of stay and complications based on Clavien-Dindo classification. Thirty one (31) patients who were recruited [gastrectomy (n = 21) and oesophagectomy (n = 10)]. Mean age was 59.2 ± 8.9 years. 21(67.7%)was male patients. Majority of the participants were SGA B (51.6%) with good ECOG status of 1(61.3%). Most of the diseases were in advanced stage [stage III (54.9%), stage IV (9.7%)].After prehabilitation, handgrip strength, peak flow meter and spirometry were significantly higher before surgery (20.9 vs 26.1, p = 0.002; 322.2 vs 419.3, p = 0.002; 77.4% vs 90.3%, p = 0.007 respectively). No significant difference in LOS and post operative complications were observed. Prehabilitation was associated with significant increase in functional capacity after intervention. Hence prehabilitation should be strongly recommended among patient undergoing major upper GI surgery to accelerate recovery from cancer surgery. However, there is insufficient data to demonstrate its role in improving clinical outcomes, including LOS and post operative complications.