A MULTIMODAL PREHABILITATION PROGRAM IN HEPATO-PANCREATO-BILIARY CANCER PATIENTS AWAITING SURGERY: PRELIMINARY RESULTS

Kasvis, P.1, 2, Bui, T.1, 3, Kilgour, R.D.1, 3, Carli, F.4, Vigano, A.1, 2

1 McGill Nutrition and Performance Laboratory, McGill University Health Centre, Montreal, Quebec, Canada
2 Supportive and Palliative Care Division, McGill University Health Centre, Montreal, Quebec, Canada
3 Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
4 Department of Anesthesia, McGill University Health Centre, Montreal, Quebec, Canada

Purpose: Multimodal prehabilitation programs have been successful in improving postoperative functional outcomes in cancer patients undergoing surgery. To date, little is known about the effect of prehabilitation on hepato-pancreato-biliary cancer (HPBC) patients. 

Objectives: To determine postoperative functional outcomes in HPBC patients following a multimodal prehabilitation program.

Methodology: Patients were randomized to either prehabilitation (prehab) or rehabilitation (rehab). Both groups received an exercise, nutrition and relaxation program; the prehab group received these interventions 4-weeks before surgery, the rehab group just after surgery. Primary outcome was change in six-minute walk test distance (6MWTD).

Results: To date, 11 patients have completed the program; 5 prehab, 6 rehab. Mean age was 55.3 ± 14.2 y. Six patients had a diagnosis of pancreatic cancer, 5 had either primary or metastatic liver cancer. Mean 6MWTD at baseline was 543.8 ± 90.5 m, with no significant differences between groups (p=0.34). Mean appendicular skeletal muscle index was below cutoffs for both men (7.06 ± 1.40 kg/m2) and women (5.43 ± 0.42 kg/m2), with no significant differences between groups (p=0.14). Four-weeks postoperatively, the average decrease in 6MWTD in the rehab group was almost doubled (prehab: -32.7 ± 17.8 m, rehab: -65.6 ± 17.6 m) and statistically different from baseline (p=0.01). After 8 weeks, the prehab 6MWTD exceeded baseline (4.0 ± 17.8 m). The rehab group failed to return to baseline (-14.6 ± 17.6 m).

Conclusion: Our preliminary results suggest HPBC patients awaiting surgery have high function, but low muscle mass. Prehabilitation may limit postoperative functional decline in HPBC patients.

16 / A MULTIMODAL PREHABILITATION PROGRAM IN HEPATO-PANCREATO-BILIARY CANCER PATIENTS AWAITING SURGERY: PRELIMINARY RESULTS