The Role of Prehabilitation in Patients Undergoing Pancreatoduodenal Resection

Abstract

Background. Currently, the introduction of pre-rehabilitation programs has shown its effectiveness in various sections of abdominal surgery, however, its role in surgical pancreatology is still not entirely clear Aim. To study the effectiveness of the implementation of pre-rehabilitation programs (preoperative exercises and diet therapy) during the waiting period for surgery and their effect on the physical and nutritional status, as well as postoperative complications and the duration of hospital stay in patients who underwent pancreatoduodenal resection. Material and methods. A prospective study was carried out including 44 patients who underwent pancreatoduodenal resection. The patients included in the study were divided into two groups. The control group (23 patients) preoperative preparation, which was carried out according to the standard method. The main group consisted of 21 patients who underwent pre-rehabilitation. Results. Among the patients in the compared groups, there were no statistically significant differences in age, gender, ASA and body mass index, concomitant diseases, and basic laboratory parameters. In the group of patients who underwent pre-rehabilitation, there was a statistically significant increase in the 6-minute walk test (p = 0.02), as well as the prognostic nutritional index (p = 0.01). There was no statistically significant difference between the compared groups in the incidence of major postoperative complications (Clavien - Dindo III / IV) (p = 0.8), clinically significant pancreatic fistulas (p = 0.5), and mortality (p = 0, 6), however, in the pre-rehabilitation group there was a significant decrease in the incidence of gastric evacuation disorders in comparison with the control group (9.5% versus 34.8%, p = 0.04). The average postoperative bed-day was 16.1 5.6 days in the pre-rehabilitation group and 19.8 6.2 days in the control group (p = 0.04). Conclusion. The introduction of pre-rehabilitation in patients undergoing pancreatoduodenal resection is effective and allows improving the physical and nutritional status of the patient, reducing the postoperative bed day and reducing the frequency of delayed gastric evacuation.