Background: Cytoreductive surgery (CRS), in combination with chemotherapy, is the main treatment for advanced-stage ovarian cancer. In vulnerable patients, this extensive surgery has a high complication risk and may lead to clinical decline. There is emerging evidence that prehabilitation could be valuable in optimizing the patient’s condition prior to cytoreductive surgery, as is shown in colorectal surgery. However, there is limited evidence in gynecologic oncology. The objective of this study is to evaluate the feasibility and effects of implementing multimodal prehabilitation before cytoreductive surgery in patients with ovarian cancer.Methods: In two Dutch hospitals, 46 patients with ovarian cancer were included during the study period, of whom 32 participated in a multimodal prehabilitation program before CRS. The programs included at least physiotherapy, dietary advice and intoxication cessation. The timing, extent and content of the programs differed. Feasibility was assessed by eligibility and participation rates and adherence to the physiotherapy program. Effectiveness was measured by differences in functional capacity, postoperative outcomes and tolerance to adjuvant chemotherapy.Results: Eligibility rates in both hospitals were 83% and 89%, and participation rates were 68% and 72%. Adherence to the physiotherapy program was moderate and only satisfactory in 55% and 63% of the patients. All fitness endpoint measurements improved compared to the baseline. No significant differences in postoperative outcomes were found between prehabilitation and control patients. Prehabilitation patients appeared to have better tolerance to adjuvant chemotherapy, with fewer dose reductions (21% vs. 73%,p= 0.017) and dose deferrals (39% vs. 46%, not significant) compared to the control group.Conclusions: The implementation of multimodal prehabilitation before CRS is feasible and effective in patients with ovarian cancer with respectable eligibility and participation rates, along with improved functional capacity, even during neoadjuvant chemotherapy.
背景：肿瘤细胞减灭术联合化疗是晚期卵巢癌的主要治疗手段。对于身体虚弱的患者，这种大范围手术具有较高的并发症风险，并可能导致临床状况恶化。新近证据表明，预康复在优化患者接受肿瘤细胞减灭术前的身体状况方面具有重要价值，这在结直肠手术中已得到证实。然而，在妇科肿瘤学领域相关证据有限。本研究旨在评估卵巢癌患者在接受肿瘤细胞减灭术前实施多模式预康复的可行性及效果。 方法：研究期间，荷兰两家医院共纳入46例卵巢癌患者，其中32例在肿瘤细胞减灭术前参与了多模式预康复计划。该计划至少包括物理治疗、饮食指导和戒除不良嗜好。各计划的实施时机、范围和内容存在差异。可行性通过患者符合条件率、参与率以及对物理治疗计划的依从性进行评估。效果通过功能状态、术后结局及辅助化疗耐受性的差异进行衡量。 结果：两家医院的患者符合条件率分别为83%和89%，参与率分别为68%和72%。患者对物理治疗计划的依从性中等，仅55%和63%的患者达到满意水平。所有体能终点指标较基线均有改善。预康复组与对照组在术后结局方面未发现显著差异。与对照组相比，预康复组患者对辅助化疗表现出更好的耐受性，剂量减少比例更低（21%对比73%，p=0.017），剂量延迟比例也更低（39%对比46%，无统计学意义）。 结论：在卵巢癌患者中实施肿瘤细胞减灭术前的多模式预康复具有可行性且效果显著，患者符合条件率和参与率均处于可接受水平，即使在接受新辅助化疗期间，患者的功能状态也能得到改善。
肿瘤(癌症)患者之家