Multimodal prehabilitation to improve functional abilities and reduce the chronic inflammatory response of frail elderly patients with gastric cancer: A prospective cohort study

Yuqi Sun; Yulong Tian; Zequn Li; Shougen Cao; Xiaodong Liu; Hongding Han; Lei Han; Lingxin Kong; Xu Zhang; Fang Liu; Cheng Meng; Gen Liu; Hao Zhong; Yanbing Zhou

doi:10.1016/j.ejso.2024.109563

Multimodal prehabilitation to improve functional abilities and reduce the chronic inflammatory response of frail elderly patients with gastric cancer: A prospective cohort study

Eur J Surg Oncol. 2024 Dec 24;51(3):109563. doi: 10.1016/j.ejso.2024.109563. Online ahead of print.

Authors

Yuqi Sun¹, Yulong Tian¹, Zequn Li¹, Shougen Cao¹, Xiaodong Liu¹, Hongding Han², Lei Han³, Lingxin Kong⁴, Xu Zhang⁵, Fang Liu¹, Cheng Meng¹, Gen Liu¹, Hao Zhong¹, Yanbing Zhou⁶

Affiliations

¹ Department of General Surgery, The Affiliated Hospital of Qingdao University, Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, Shandong, China.
² Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China.
³ Department of Nutrition, The Affiliated Hospital of Qingdao University, Qingdao, China.
⁴ Department of Rehabilitation Physiotherapy, The Affiliated Hospital of Qingdao University, Qingdao, China.
⁵ Department of Clinical Psychology, The Affiliated Hospital of Qingdao University, Qingdao, China.
⁶ Department of General Surgery, The Affiliated Hospital of Qingdao University, Gastrointestinal Tumor Translational Medicine Research Institute of Qingdao University, Qingdao, Shandong, China. Electronic address: zhouyanbing@qduhospital.cn.

PMID: 39733587
DOI: 10.1016/j.ejso.2024.109563

Abstract

Background: Population ageing and cancer burden are important global public health problems that pose unprecedented threats to health systems worldwide. Frailty is a common health problem among elderly patients with cancer. In recent years, the use of prehabilitation to improve frailty has received widespread attention. Few studies have addressed the specific physiologic effects of prehabilitation on patients undergoing surgery.

Methods: Frail elderly patients (aged at least 65 years) who underwent elective primary surgery for gastric cancer between September 2022 and October 2023 were included in this single-centre prospective cohort study and were categorized into multimodal prehabilitation or ERAS standard care groups. Prehabilitation, including physical and respiratory training, nutritional support and psychosocial treatment, was provided at least two weeks before gastrectomy. The primary outcome was functional status. Secondary outcomes included changes in indices of lipid metabolism, oxidative stress and chronic inflammation.

Results: Over a 13-month period, 137 participants were assessed for eligibility, and 110 patients (prehabilitation 55, ERAS 55) were analysed. Compared with the baseline, patients in the prehabilitation group exhibited increased physical capacity before the operation (mean 6-min walk test change +28 m; P < 0.001). After prehabilitation intervention, inflammation-related indicators (NLR, PLR, SII and CRP) improved, and proinflammatory cytokine production (IL-5, IL-6, IL-1β, IL-10 and TNF-α) decreased. After surgery, the increase in IL-6 was reduced in the prehabilitation group (P = 0.036). Moreover, prehabilitation was associated with alleviating oxidative stress as determined by the levels of MDA (P = 0.005).

Conclusion: Multimodal prehabilitation can play a beneficial role in improving functional abilities by reducing chronic inflammation, improving lipid metabolism, and attenuating oxidative stress.

Keywords: Frail elderly patients; Functional capacity; Mechanism; Multimodal prehabilitation.