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Physiotherapy Regimens in Esophagectomy and Gastrectomy: a Systematic Review and Meta-Analysis
- Source :
- Annals of Surgical Oncology. 29:3148-3167
- Publication Year :
- 2021
- Publisher :
- Springer Science and Business Media LLC, 2021.
-
Abstract
- Background Esophageal and gastric cancer surgery are associated with considerable morbidity, specifically postoperative pulmonary complications (PPCs), potentially accentuated by underlying challenges with malnutrition and cachexia affecting respiratory muscle mass. Physiotherapy regimens aim to increase the respiratory muscle strength and may prevent postoperative morbidity. Objective The aim of this study was to assess the impact of physiotherapy regimens in patients treated with esophagectomy or gastrectomy. Methods An electronic database search was performed in the MEDLINE, EMBASE, CENTRAL, CINAHL and Pedro databases. A meta-analysis was performed to assess the impact of physiotherapy on the functional capacity, incidence of PPCs and postoperative morbidity, in-hospital mortality rate, length of hospital stay (LOS) and health-related quality of life (HRQoL). Results Seven randomized controlled trials (RCTs) and seven cohort studies assessing prehabilitation totaling 960 patients, and five RCTs and five cohort studies assessing peri- or postoperative physiotherapy with 703 total patients, were included. Prehabilitation resulted in a lower incidence of postoperative pneumonia and morbidity (Clavien–Dindo score ≥ II). No difference was observed in functional exercise capacity and in-hospital mortality following prehabilitation. Meanwhile, peri- or postoperative rehabilitation resulted in a lower incidence of pneumonia, shorter LOS, and better HRQoL scores for dyspnea and physical functioning, while no differences were found for the QoL summary score, global health status, fatigue, and pain scores. Conclusion This meta-analysis suggests that implementing an exercise intervention may be beneficial in both the preoperative and peri- or postoperative periods. Further investigation is needed to understand the mechanism through which exercise interventions improve clinical outcomes and which patient subgroup will gain the maximal benefit.
- Subjects :
- EXERCISE THERAPY
ANESTHESIA
Science & Technology
ENHANCED RECOVERY
MULTICENTER
Pneumonia
Length of Stay
PREOPERATIVE RESPIRATORY REHABILITATION
CANCER
Esophagectomy
Postoperative Complications
Oncology
QUALITY-OF-LIFE
Gastrectomy
ABDOMINAL-SURGERY
Humans
Surgery
Life Sciences & Biomedicine
INTERVENTION
Physical Therapy Modalities
11 Medical and Health Sciences
POSTOPERATIVE PULMONARY COMPLICATIONS
Subjects
Details
- ISSN :
- 15344681 and 10689265
- Volume :
- 29
- Database :
- OpenAIRE
- Journal :
- Annals of Surgical Oncology
- Accession number :
- edsair.doi.dedup.....a09d0f7da03612fd6014cecd9874f56c