Page 24 - Read Online

Mohan et al. Hepatoma Res 2020;6:13 I http://dx.doi.org/10.20517/2394-5079.2019.53 Page 3 of 10

Figure 1. Age related physiological changes by system [2]

undergoing renal transplant and showed improved graft function, aerobic fitness, quality of life and patient
reported physical functionality. Similar reports were also found in reviews of patients undergoing renal
[14]
transplant [12,13] . Mayo et al. reported 95 patients with colorectal resections and showed increased functional
[15]
outcomes such as in the 6-min walking test in 33% of patients. A recent meta-analysis by Gillis et al.
also showed that prehabilitation could reduce post-operative admissions by two days in patients who
underwent colorectal surgery. A systemic review by Cabilan et al. , included 13 orthopedic, one
[16]
colorectal, two cardiac and one foregut study. Prehabilitation did not demonstrate benefits in objective and
self-reported function or reduction in inpatient rehabilitation admission. Some studies include cognitive
[17]
behavioral therapy in addition to prehabilitation and this introduces heterogeneity . As such, more studies
are needed to establish the role of prehabilitation and define patient selection criteria. Prehabilitation
should be personalized based on various factors such as: (1) surgery: type, duration, expected blood loss,
predicted morbidity and mortality; (2) patient factors: age, frailty, sarcopenia, co-morbidity, caregiver
support; and (3) pathology: malignancy, burden of disease, malnutrition, cachexia, emotional impact.

PREHABILITATION IN HEPATO-PANCREATICO-BILIARY SURGERY
Hepato-pancreatico-biliary surgery is complex and many units have adopted prehabilitation. In a local
[18]
study including 245 patients with liver resection the post-operative morbidity, 30-day mortality and 90-day
mortality was 38.3%, 2.4% and 3.7% respectively. In a local study including 196 patients with pancreatic
[19]
resection, the rate of grade B and C post-operative pancreatic fistula, 30-day mortality and 90-day mortality
was 5.1%, 0.5% and 2%, respectively. Prehabilitation has potential to improve peri-operative outcomes.
In a propensity-score matched study including 76 patients undergoing major hepato-pancreatico-biliary