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Mohan et al. Hepatoma Res 2020;6:13 Hepatoma Research
DOI: 10.20517/2394-5079.2019.53

Review Open Access

Prehabilitation in elderly patients scheduled for liver
resection and protocol for Recovery Of Surgery in

Elderly

Ramkumar Mohan , Cheong Wei Terence Huey , Sameer Junnarkar , Jee Keem Low , Vishal G. Shelat
2
2
2
1
2
1 Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
2 Senior Consultant, Hepatopancreaticobiliary Surgery, Tan Tock Seng Hospital, Singapore.
Correspondence to: Ramkumar Mohan, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
E-mail: m.ramkumar@u.nus.edu
How to cite this article: Mohan R, Huey CWT, Junnarkar S, Low JK, Shelat VG. Prehabilitation in elderly patients scheduled for
liver resection and protocol for recovery of surgery in elderly. Hepatoma Res 2020;6:13.
http://dx.doi.org/10.20517/2394-5079.2019.53

Received: 25 Dec 2019 First Decision: 2 Mar 2020 Revised: 12 Mar 2020 Accepted: 18 Mar 2020 Published: 26 Mar 2020
Science Editor: Bruno Nardo Copy Editor: Jing-Wen Zhang Production Editor: Jing Yu

Received: First Decision: Revised: Accepted: Published:
Abstract
Science Editor: Copy Editor: Production Editor: Jing Yu
Ageing population of first world economies pose unique challenges to surgical community. Enhanced recovery after
surgery protocols and pathways do not attempt to optimize or enhance physical function of patients by customized
program of physical activity. Increasingly, prehabilitation programs (PP) have gained momentum in orthopaedics,
urology, colorectal surgery and hepatopancreaticobiliary surgery. Current evidence of PP in various elective surgical
procedures have shown improved outcomes with minimal to none drawback or harm. There is emerging evidence of
role of PP in elective liver resection. The aim of this paper is to review the basis of PP and share local multidisciplinary
team protocol specifically customized to frail and elderly population - Recovery Of Surgery in Elderly.

Keywords: Prehabilitation, liver resection, hepatocellular carcinoma, pre-operative exercise, ageing

INTRODUCTION
Liver is the largest solid intra-abdominal organ and common site for primary and metastatic cancers. The
most common liver malignancy is secondary from gastrointestinal tract with colorectal liver metastasis
being the commonest. Hepatocellular carcinoma is the most common primary liver cancer and fifth most
common cancer worldwide . Hepatocellular carcinoma occurs in elderly population and the incidence is
[1]
expected to rise with epidemic of diabesity as well as ageing population. With increased participation in

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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