Author(s): LAZA CAGIGAS, R., RAMPAL, T., LARUMBE-ZABALA, E., SEIJO, M., NACLERIO, F., Institution: UNIVERSITY OF GREENWICH, Country: UNITED KINGDOM, Abstract-ID: 720

INTRODUCTION:
Cardiopulmonary exercise testing is frequently utilised in the United Kingdom to assess patients’ functional capacity prior to elective surgery. Both peak oxygen (VO2Peak) and the amount of oxygen consumed at the 1st ventilatory threshold have been used as markers of functional capacity with low values linked to morbidity and mortality in the postoperative period. Surgical prehabilitation (PREHAB) is an intervention including one or more lifestyle components (e.g., exercise) implemented to enhance functional capacity in patients awaiting surgery.
We aimed to systematically summarize the effects of PREHAB on VO2Peak in patients awaiting oncologic resection.
METHODS:
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist and registered with the International Prospective Register of Systematic Reviews, PROSPERO (CRD42023428676). The search of the literature was conducted using Cochrane Library, EBSCOhost, Google Scholar, MEDLINE PubMed, and Web of Science from March 2023 to October 2023. Inclusion criteria were randomized controlled trials (RCT), including adult patients (≥18 years old), diagnosed with any type of cancer, who could be undergoing or not neo-adjuvant chemotherapy, implementing any type of PREHAB modality (i.e., unimodal or multimodal), delivered at any venue (i.e., home, hospital or in the community), by any means (i.e., telehealth or face-to-face) and including at least an intervention group (PREHAB) and one control group (standard care). Continuous data on VO2Peak as a marker of functional capacity were pooled using a random-effects model. The Comprehensive Meta-Analysis Software, v. 4.0.000 (Biostat Inc., Englewood, New York, USA) was used for the analysis.
RESULTS:
Seven RCTs reporting VO2Peak met the inclusion criteria. The overall quality of the included studies was high, with a low risk of bias, scoring from 2 to 5 points in the Cochrane collaboration tool. All the studies included an exercise component. Two studies implemented multimodal prehabilitation and five implemented unimodal exercise-based prehabilitation. The mean effect size (Hedges’ g) of PREHAB vs. standard care on VO2Peak was medium (n = 7, g= 0.615, 95% CI 0.243 to 0.987), and statistically significant (Z = 3.240, p = 0.001). The prediction interval was calculated from -0.562 to 1.793 (95% CI). The sensitivity analysis showed that none of the studies contributed disproportionately to the results of the meta-analysis and no outliers were identified amongst the analysed studies.
CONCLUSION:
Considering the overall findings and the estimated prediction interval from the seven meta-analysed RCTs, we are unable to support the claim that PREHAB improves VO2Peak.