Multimodal Prehabilitation for Resectable Gastric Cancer

Chinese PLA General Hospital70 enrolled

Overview

Surgical resection is the mainstay for gastric cancer. Surgical stress response, like insulin resistance and catabolism, is inevitable and is a risk factor for postoperative outcome. To cope with this stress, the enhanced recovery protocol has been proposed and successfully implemented in clinical practice. Recently, prehabilitation have attracted increasingly attention, which is the preoperative part of enhanced recovery pathway. Prehabtilitation are bundles of evidenced elements in order to improve patient's functional capacity. Patients with gastric cancer are usually suffered from nutritional risk, anxiety and frailty. In this trial, we investigate whether multimodal prehabilitation (exercise, nutrition and psychological support) could improve patient's functional status to better tolerate surgical trauma.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Stomach Neoplasm

Interventions

Patient with gastric cancer received two weeks of prehabilitation intervention. An individualized exercise program was established according to the FITT (Frequency, Intensity, Time and Type) principle. Aerobic exercise: 3-5 times/week, 30-60 min jogging or brisk walking per time, intensity based on heart rate and modified Borg-scale. Resistance exercise: 2-3 times/week, 10-12 RM per sets, 2-3 sets with 2 min interval rest, seated knee up, knee extension, etc. Nutritional support: 30kcal/kg/d, 1.5mg/kg/d protein, oral nutritional supplement with suggested recipes. Psychological support: provided with guidance on gastric cancer, regular online chat through Wechat, alcohol quitting, smoking cessation and light music.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Pathologically confirmed gastric cancer, clinical I-III TNM stage (AJCC 8th edition); * Will receive curative-intent surgery; * Life expectance \> 6 months; Exclusion Criteria: * Gastric stump cancer or combined with other malignances; * NYHA III, NYHA IV; * Inability to swallow, with gastrostomy, or inability to move because of orthopedic disease or neuromuscular disease; * Psychiatric disorders, COPD, end-stage hepatic or renal disease, uncontrolled cardiac arhythmia or uncontrolled hypertention; * Receiving immunosuppressive therapy; * Emergency surgery because of tumor bleeding or tumor perforation;

Outcomes

Primary Outcomes

Duke Activity Status Index before surgery

Duke Activity Status Index score is a 12-item self-reported questionnaire that assesses daily activities such as personal care, ambulation, household tasks, and recreation with respective metabolic costs. Duke Activity Status Index score ranges from 0 to 58.2. The higher score indicates the better functional status. Duke Activity Status Index has been recommended by European Society of Cardiology guidelines for functional assessment of patients undergoing non-cardiac surgery.

Time frame: Duke Activity Status Index score on the day before surgery

Secondary Outcomes

Morbidity

Postoperative complication

Time frame: In postoperative 30 day after gastrectomy

Postoperative hospital stay

Period from day of surgery to day of discharge from hospital

Time frame: During the postoperative 30 day period

30-day readmission rate

Proportion of patients admitted to the hospital after discharge because of complications