Multimodal Prehabilitation and Perioperative Immune Function in Patients Undergoing Abdominal Cancer Surgery.
Source: PubMed, NCBI / U.S. National Library of Medicine
Prehabilitation is an emerging preoperative strategy designed to optimise patients' functional capacity before surgery to improve postoperative outcomes. Previous studies have demonstrated its clinical benefit, including enhanced recovery and reduced postoperative complications. However, the mechanisms underlying these benefits remain poorly understood. This exploratory study investigates the potential effects of prehabilitation on pre- and postoperative immune function. This prospective study utilized data and material from a subgroup of patients participating in the F4S PREHAB trial, which is a stepped-wedge trial investigating the effects of multimodal prehabilitation prior to major surgery. In this substudy, patients undergoing elective bladder, oesophageal, or rectal cancer surgery between June 2022 and November 2023, were included. Immune function was assessed at baseline, following the prehabilitation or usual care period, and on postoperative day 1 (POD1) by examining ex vivo cytokine production capacity, plasma cytokine concentrations, and mHLA-DR expression. This substudy included 130 patients: 102 in the prehabilitation group and 28 in the control group. Following prehabilitation, ex vivo production of pro-inflammatory cytokines was reduced, while ex vivo production of the anti-inflammatory cytokine IL-10 was increased. Plasma concentrations of IL-6 and IL-10 were decreased following prehabilitation. On POD1, no significant differences in postoperative immune funct
Abstract
Prehabilitation is an emerging preoperative strategy designed to optimise patients' functional capacity before surgery to improve postoperative outcomes. Previous studies have demonstrated its clinical benefit, including enhanced recovery and reduced postoperative complications. However, the mechanisms underlying these benefits remain poorly understood. This exploratory study investigates the potential effects of prehabilitation on pre- and postoperative immune function. This prospective study utilized data and material from a subgroup of patients participating in the F4S PREHAB trial, which is a stepped-wedge trial investigating the effects of multimodal prehabilitation prior to major surgery. In this substudy, patients undergoing elective bladder, oesophageal, or rectal cancer surgery between June 2022 and November 2023, were included. Immune function was assessed at baseline, following the prehabilitation or usual care period, and on postoperative day 1 (POD1) by examining ex vivo cytokine production capacity, plasma cytokine concentrations, and mHLA-DR expression. This substudy included 130 patients: 102 in the prehabilitation group and 28 in the control group. Following prehabilitation, ex vivo production of pro-inflammatory cytokines was reduced, while ex vivo production of the anti-inflammatory cytokine IL-10 was increased. Plasma concentrations of IL-6 and IL-10 were decreased following prehabilitation. On POD1, no significant differences in postoperative immune function were observed between the prehabilitation and control groups. This study suggests that multimodal prehabilitation influences basal immune function, leading to a less inflammatory state. However, as no significant differences in immune function were observed between prehabilitation and control groups on POD1, the impact of prehabilitation on postoperative immune function may be limited.