Background/Objectives: Major surgery for gastrointestinal cancer carries a 50% risk of postoperative complications. Physiotherapists commonly provide interventions to patients undergoing gastrointestinal surgery for cancer with the intent of preventing complications and improving recovery. However, the evidence is unclear if physiotherapy is effective compared to providing no physiotherapy, nor if timing of service delivery during the perioperative pathway influences outcomes. The objective of this review is to evaluate and synthesise the evidence examining the effects of perioperative physiotherapy interventions delivered with prophylactic intent on postoperative outcomes compared to no treatment or early mobilisation alone. Methods: A protocol was prospectively registered with PROSPERO and a systematic review performed of four databases. Randomised controlled trials examining prophylactic physiotherapy interventions in adults undergoing gastrointestinal surgery for cancer were eligible for inclusion. Results: Nine publications from eight randomised controlled trials were included with a total sample of 1418 participants. Due to inconsistent reporting of other perioperative complications, meta-analysis of the effect of physiotherapy was only possible specific to postoperative pulmonary complications (PPCs). This found an estimated 59% reduction in risk with exposure to physiotherapy interventions (RR 0.41, 95%CI 0.23 to 0.73,p< 0.001). Sub-group analysis demonstrated that timing of delivery may be important, with physiotherapy delivered only in the preoperative phase or combined with a postoperative service significantly reducing PPC risk (RR 0.32, 95%CI 0.17 to 0.60,p< 0.001) and hospital length of stay (MD–1.4 days, 95%CI −2.24 to −0.58,p= 0.01), whilst the effect of postoperative physiotherapy alone was less certain. Conclusions: Preoperative-alone and perioperative physiotherapy is likely to minimise the risk of PPCs in patients undergoing gastrointestinal surgery for cancer. This challenges current traditional paradigms of providing physiotherapy only in the postoperative phase of surgery. A review with broader scope and component network analysis is required to confirm this.
背景/目的：胃肠道癌症大手术术后并发症风险高达50%。物理治疗师常为接受胃肠道癌症手术的患者提供干预措施，旨在预防并发症并促进康复。然而，目前尚不清楚物理治疗相较于不进行物理治疗是否有效，也不明确围手术期干预时机是否影响预后。本综述旨在评估和综合相关证据，比较以预防为目的的围手术期物理治疗干预与不治疗或仅早期活动对术后结局的影响。方法：研究方案已在PROSPERO前瞻性注册，并对四个数据库进行了系统综述。纳入标准为评估接受胃肠道癌症手术的成人患者预防性物理治疗干预的随机对照试验。结果：共纳入8项随机对照试验的9篇文献，总样本量为1418名参与者。由于其他围手术期并发症的报告不一致，仅能针对术后肺部并发症（PPCs）进行物理治疗效果的荟萃分析。结果显示，接受物理治疗干预可使PPCs风险降低约59%（RR 0.41，95%CI 0.23至0.73，p<0.001）。亚组分析表明干预时机可能至关重要：仅术前或围手术期联合干预能显著降低PPCs风险（RR 0.32，95%CI 0.17至0.60，p<0.001）并缩短住院时间（MD -1.4天，95%CI -2.24至-0.58，p=0.01），而单纯术后物理治疗的效果尚不明确。结论：单纯术前及围手术期物理治疗可能降低胃肠道癌症手术患者的PPCs风险。这对当前仅术后提供物理治疗的传统模式提出了挑战。需通过更广泛范围的综述及成分网络分析加以验证。
肿瘤(癌症)患者之家