Oncologie et MPR
Le 15/10/2021 de 09:00 à 10:30
La pré-habilitation avant chirurgie carcinologique colo-rectale pourrait améliorer la reprise du transit intestinal : étude cas-témoin
Fabienne Fabulas (Angers, France), Paul Paisant (Angers, France), Mickael Dinomais (Angers, France), Stéphanie Mucci (Angers, France), Christine Casa (Angers, France), Paul Le Naoures (Angers, France), Jean François Hamel (Angers, France), Jeanne Perrot (Angers, France), Aurélien Venara (Angers, France)
Objective : While its effect is controverted, multimodal pre-habilitation could be used to improve postoperative course after colorectal cancer surgery. However, by increasing lean body mass, pre-habilitation could reduce the time for gastrointestinal (GI) functions recovery. The aim of the study was to assess the impact of pre-habilitation for colorectal cancer surgery on postoperative GI motility recovery.
Material / Patients and Methods : This is a matched retrospective study based on a prospective database including patients undergoing colorectal surgery without pre-habilitation (group NPH) (2016-2018) and with pre-habilitation (group PH) (2018-2019). The main outcome measure was the time to GI-3 recovery (tolerance to solid food and flatus and/or stools).
Results : 113 patients were included, 37 had pre-habilitation (32.7%). The age, the surgical procedure, the surgical access, the rate of synchronous metastasis, the rate of chemoradiotherapy and the rate of stoma were more important in the PH group. Conversely, the rate of patients with ASA score>2 was higher in the NPH group. By matching patients according to age, gender and surgical procedure, 84 patients were compared (61 in the group NPH and 23 in the group PH). The mean of GI-3 recovery was significantly lower in the PH group. The other endpoints were not significantly different but time to GI functions recovery and medical morbidity tended to be higher in the group NPH. The compliance with the enhanced recovery program was significantly higher in the group PH.
Discussion - Conclusion : Pre-habilitation before colorectal cancer surgery reduced time to GI functions recovery and may increase the compliance of enhanced recovery program.
Keywords : Colorectal cancer surgery, pre-habilitation, gastrointestinal functions, enhanced recovery programs.