Background: Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) remains the standard of care for peritoneal surface malignancies but carries significant postoperative risks. In low- and middle-income countries (LMICs), the challenge is magnified by limited access to high-cost enhanced recovery programs. The SCODA (Surgical Complication Optimization through Diet and Activity) program was developed as a low-cost prehabilitation intervention to improve outcomes in resource-constrained settings.Methods: This retrospective cohort study included 169 patients undergoing CRS ± HIPEC at a single academic center in Morocco between 2015 and 2023. Patients treated before SCODA implementation (pre-SCODA group,n= 83) were compared to those enrolled in the SCODA program (SCODA group,n= 86). SCODA included oral iron supplementation, a protein-rich food-based diet, and progressive walking sessions over 90 days. Perioperative outcomes, including pulmonary complications, major morbidity (Clavien–Dindo ≥ 3b), transfusions, ICU stay >3 days, and 90-day mortality, were analyzed using univariate and multivariate logistic regression models.Results: The SCODA group had significantly fewer pulmonary complications (2% vs. 13%,p= 0.008), reduced major morbidity (9% vs. 21%,p= 0.031), fewer transfusions (8% vs. 20%,p= 0.024), and shorter ICU stays (median 1.5 vs. 5 days,p< 0.001). Ninety-day mortality was also lower in the SCODA group (5.8% vs. 12.4%,p= 0.046). SCODA participation remained an independent protective factor in multivariate analyses for all endpoints except major complications.Conclusions: The SCODA program is a feasible and effective prehabilitation strategy for improving surgical outcomes after CRS/HIPEC in LMICs. Its low-cost, food-based, and activity-centered design may support broader implementation in resource-limited environments and inform future perioperative care policies in oncology.
背景：细胞减灭术联合或不联合腹腔热灌注化疗是腹膜表面恶性肿瘤的标准治疗方案，但术后风险较高。在中低收入国家，高昂的加速康复项目可及性有限进一步加剧了治疗挑战。SCODA（通过饮食与活动优化手术并发症）项目作为一种低成本预康复干预措施，旨在改善资源有限环境下的治疗结局。 方法：本回顾性队列研究纳入2015年至2023年间摩洛哥某学术中心接受细胞减灭术±腹腔热灌注化疗的169例患者。将SCODA项目开展前接受治疗的患者（前SCODA组，n=83）与参与SCODA项目的患者（SCODA组，n=86）进行对比。SCODA项目包含为期90天的口服铁剂补充、富含蛋白质的膳食方案及渐进式步行训练。采用单因素与多因素逻辑回归模型分析围手术期结局指标，包括肺部并发症、主要并发症（Clavien-Dindo分级≥3b）、输血需求、ICU住院时间>3天及90天死亡率。 结果：SCODA组肺部并发症发生率显著降低（2% vs. 13%，p=0.008），主要并发症减少（9% vs. 21%，p=0.031），输血需求下降（8% vs. 20%，p=0.024），ICU住院时间缩短（中位数1.5天 vs. 5天，p<0.001）。该组90天死亡率亦更低（5.8% vs. 12.4%，p=0.046）。多因素分析显示，除主要并发症外，参与SCODA项目是所有观察终点的独立保护因素。 结论：SCODA项目是中低收入国家改善细胞减灭术/腹腔热灌注化疗术后结局的可行且有效的预康复策略。其低成本、以膳食为基础、以活动为中心的设计模式，有助于在资源有限环境中推广应用，并为未来肿瘤围手术期护理政策制定提供参考。
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