Preconditioning prior to visceral oncological surgery. A paradigm shift in visceral surgery?

BackgroundPostoperative complications after complex visceral oncological surgery can lead to substantial impairment of patients. In addition, preoperative physical performance and the severity of postoperative complications determine the long-term recovery process of physical function. Therefore, preconditioning in the preoperative period should be an important part of the preoperative/neoadjuvant treatment.ObjectiveThe aim of this article is acritical appraisal of current concepts of prehabilitation as well as their development potential and applicability in visceral surgery.Material and methodsBased on aselective literature review, current studies and implemented concepts are presented and therapy algorithms are provided.ResultsThis study differs in primary outcome, design and temporal framework of the intervention. The study results showed positive effects of an active increase in physical fitness in the preoperative period with respect to the quality of life, convalescence and postoperative pulmonary complication rate.DiscussionIn addition to the assessment of the individual risk of complications by means of spiroergometry, atargeted nutrition and exercise program can increase the individual performance level prior to visceral surgery and, thus, influence the postoperative risk of complications. The performance should be understood as amodifiable risk factor, which can also be positively influenced in the preoperative phase, even in ashort time period. Individual preoperative care optimizes the physical and psychological situation of patients. To ensure the required individual care, approaches must be created and pursued, which can be implemented in adecentralized way.