Impacto da pré-habilitação no prognóstico pós-operatório de doentes oncológicos de alto risco: uma revisão sistemática e meta-análise

Abstract

Introduction. Surgical treatment plays a key role in the treatment of solid tumors and increases the life extension of cancer patients. However, despite this, it may cause significant morbidity and mortality, particularly in high-risk patients. This systematic review and meta-analysis aimed to assess the impact of pre-habilitation in postoperative complications (CPO), mortality, length of hospitallization stay, readmission and functional capacity in cancer patients at high-risk (defined as frail or older than 70 years and / or a score ASA III-IV) for surgical adverse effects Methodology: Randomized and nonrandomized controlled studies were searched in the Pubmed, Ebsco and Web of Science databases. Quality assessment of included articles was made through Downs and Blacks. For the quantitative evaluation, the software ReviewManager 5.2 (RevMan 2016) was used. PRISMA recommendations were followed. Results: 136 articles were found, of which only 6 were eligible for qualitative and quantitative evaluation (4 randomized and 2 non-randomized). The analysis resulted in a total of 674 participants, with an average age of 78 years, mostly male. Participants presented high (4 studies) or low gastrointestinal cancer (2 studies) and were mainly submitted to major surgery. The high risk for PCO was defined by the presence of frailty (3 studies) and age> 70 years and or ASA III-IV (3 studies). Pre-habilitation promoted a reduction in the risk of serious complications (RR 0.60, 95% CI: 0.41 - 0.88, p = 0.010; i² = 0%, p = 0.83), cardiac complications (RR 0.19, 95% CI: 0.07 - 0.53, p = 0.001; I² = 0%, p = 0.41), mortality (RR 0.28, 95% CI: 0.14- 0.60; p = 0.0008; I² = 48% and p = 0.13) and length of hospital stay (- 4.26, 95% CI: -8.21 to -0.30, p = 0 , 03; I² = 81% and p = 0.001). There was no significant effect for general complications (RR 0.80, 95% CI: 0.55-1.17, p = 0.24; I² = 67% and p = 0.02), pulmonary complications (RR 1, 10, 95% CI 0.12 to 8.63, I² = 69%, p = 0.99) or surgical (RR 0.46 95% CI 0.16 to 1.55, I² = 79%, p = 0.16) or readmission (RR 0.73, 95% CI: 0.39 to -1.36, p = 0.32; I² = 38% and p = 0.20). Conclusion: Our work suggests that pre-habilitation is effective in reducing postoperative morbidity and mortality in cancer patients at high-risk for surgical burden.