Prehabilitation in HBP surgery

-9]. Irrespective of the assessment tool used, a number studies have indicated that frailty is associated with surgical outcomes and survival [5-13]. Therefore, it considered frail patients may be possible candidates for prehabilitation.Effect prehabilitationPrehabilitation strongly endorsed in ERAS® recommendation [14]. However, effect prehabilitation HBP cancer still unclear. In randomized controlled study analyzed impact on postoperative undergoing pancreaticoduodenectomy (PD), did not reduce complications. delayed gastric emptying was reduced [15]. Perlmutter et al. [16] also reported affect hospital stay, complications, 90-day readmission rates after PD. another RCT, however, Barberan-Garcia [17] enhanced high-risk elective major abdominal surgery. Katsourakis [18] carried out RCT which evaluated quality life (QoL) who underwent pancreatic resection. They exercise improved QoL pancreatectomy. large-scale retrospective study, Yamaue [19] might pulmonary complications shorten stay Fard-Aghaie [20] demonstrated liver regeneration ALPPS by means physical an animal experiment. Lin [21] feasibility prehabilitataion improving Liver Frailty Index, functional capacity, transplantation candidates. Because heterogeneity studies, results meta-analyses are inconclusive [22-25]. On one hand, meta-analysis Dagorno [22], regard to surgery, had no length (LOS) or rate other Lambert [24] shortened LOS prehabilitation. Bundred [23] improvement LOS, DGE, muscle mass, functioning following prehabilitation, but outcomes. Daniels [26] decreased multimodal “exercise only” Despite divergency above results, many have, nevertheless, benefits suggesting such program improve outcomes, survival, [21,27].How do “prehabilitation”?An international research consortium created “best practice” approach colorectal surgery 2016. This four-pillar consists high-intensity interval training endurance strength; nutritional support protein vitamin supplementation; mental support; smoking cessation [28]. has been adopted clinical as well response subsidiary requests diseases than cancer. Hence should multimodal, individualized according capacity patient.Closing remarksFrailty important risk factor cancer, older before planned The waiting period optimal time psychological conditioning patients. There evidences related outcome survival. “marginal gain” obtained from may, therefore, induce significant when aggregated strategies.