多模式预康复策略对老年衰弱结直肠癌手术患者功能状态及短期预后影响的多中心回顾性研究

Effect of multimodal prehabilitation strategies on functional capacity and short-term outcomes after colorectal cancer surgery in frail elderly patients: a multicenter retrospective study

摘要:

目的 探讨多模式预康复策略对老年衰弱结直肠癌手术患者的功能状态及短期预后的影响。 方法 回顾性收集2021年1月—2023年6月接受手术治疗的老年衰弱结直肠癌患者的临床资料，所有患者均采用加速康复外科(enhanced recovery after surgery, ERAS)路径管理，依据是否实行多模式预康复分为预康复组和对照组。采用1∶2倾向性评分匹配平衡组间基线差异所致的混杂偏倚，比较匹配后两组患者资料，卡钳值设为0.1。主要观察指标为术后4周6分钟步行距离(6-minute walk distance, 6MWD)；次要观察指标为衰弱指数(frail index, FI)、手术时间、术中出血量、术后并发症、术后住院时间、术后30 d再入院率/再手术率及术后90 d死亡率。 结果 本研究最终共纳入182例患者(上海交通大学医学院附属第九人民医院62例，临沂市人民医院61例，聊城市人民医院59例)，预康复组31例，对照组151例。经1∶2匹配后成功匹配93例患者，预康复组31例，对照组62例。术后4周预康复组6MWD改善值大于对照组[(46.3±33.7) m vs (7.6±30.2) m, P = 0.002)]，预康复组6MWD改善值>20 m的患者数占比多于对照组(55% vs 9.9%,P=0.033)。FI预康复组小于对照组(中位数2 vs 3,P=0.024)。两组间手术时间、并发症发生率、术后30 d再入院率/再手术率及术后90 d死亡率差异无统计学意义(P＞0.05)。术后住院时间预康复组长于对照组[(14.0±4.3) d vs (11.3±4.2) d,P=0.007]。 结论 多模式预康复策略未增加围手术期风险，有助于改善老年衰弱结直肠癌患者术后功能状态，可能提高患者对手术应激的耐受性，从而使其更好地从ERAS中获益。

Abstract:

Objective To explore the effect of multimodal prehabilitation strategies on the functional capacity and short-term outcomes for elderly frail patients after colorectal cancer surgery. Methods From January 2021 to June 2023, the clinical data of patients receiving colorectal cancer surgery were collected retrospectively. All patients were managed using the enhanced recovery after surgery(ERAS) pathway, and were divided into prehabilitation group and control group based on whether multimodal prehabilitation was implemented. A 1∶2 propensity score matching was applied to balance the confounding factors due to baseline differences between groups, and the caliper value was set to 0.1. The main observation indicator was 6-minute walk distance(6MWD) of 4 weeks after surgery; the secondary observation indicator was frail index(FI), operation time, intraoperative blood loss, postoperative complications, length of postoperative hospital stay, 30-day postoperative readmission rate, 30-day reoperation rate, and 90-day postoperative mortality rate. Results This study included 182 patients(62 patients from the Ninth People’s Hospital Affiliated with Shanghai Jiao Tong University School of Medicine, 61 patients from Linyi People’s Hospital, and 59 patients from Liaocheng People’s Hospital), 31 patients in the prehabilitation group and 151 patients in the control group. A total of 31 patients were included in the prehabilitation group and 62 patients in the control group after 1∶2 propensity score matching. At 4 weeks after the surgery, the improvement of 6MWD in the prehabilitation group was greater than that in the control group [(46.3±33.7) m vs (7.6±30.2) m, P=0.002)], the proportion of patients with an improvement in 6MWD)>20 m in the pre-rehabilitation group was higher compared to the control group(55% vs 9.9%, P=0.033). The FI of prehabilitation group was lower than the control group(median 2 vs 3, P=0.024). There was no significant differences in operation time, complication rate, 30-day postoperative readmission rate, 30-day reoperation rate, and 90-day postoperative mortality between the prehabilitation group and the control group(all P>0.05). The postoperative hospital stay of the prehabilitation group was longer than that in the control group [(14.0±4.3) d vs (11.3±4.2) d, P=0.007)]. Conclusion The multimodal prerehabilitation strategy will not increase the perioperative risk, and can improve the postoperative functional capacity of elderly frail patients after colorectal cancer surgery. It may enhance the patients’ tolerance to surgical stress, thereby enabling them to better benefit from ERAS.