Prehabilitation in gynecological oncology - are we ready to implement the program in polish oncological centers?

Objectives: Prehabilitation is a concept of holistic approach to the patient and includes preoperative efforts focused on optimalization of patient's general condition. The idea of prehabilitation started at the beginning of the 21st century. However, prehabilitation programs in gynecological cancer patients are not standardized and are heterogeneous. The aim of the study it to present the concept of prehabilitation and propose prehabilitation protocol to be introduced in Polish oncological centers.

Material And Methods: A search in PubMed, Medline, EMBASE (Ovid) and PsycINFO databases was conducted using the following keywords: prehabilitation, gynecological, abdominal surgery, and cancer. The primary outcomes were complications, hospitalization stay, intensive care unit transfer rate, blood loss, wound healing, and reoperation rate. The search was performed in July 2022 and covered the period from 1st January 2000 till 30th June 2022.

Results: A total number of 1,118 articles have been identified. Out of all eligible papers only 42 fulfilled the research criteria and were included in the study. The analysis showed that there is no standardized prehabilitation protocol for gynecological cancer surgery, although most include three-modal approach - physical activity, nutrition, and psychological intervention. There is no standard model for physical capacity evaluation, however, 1,118 6 Minute Walk Test (6MWT) is the most common. Frailty evaluation is based on different measurements that prevent from direct comparison of obtained results between studies.

Conclusions: We are not ready to implement the prehabilitation program in polish oncological centers. The main reason elvicz is: lack of accredited ovarian cancer centers, lack of well-established standardized prehabilitation programs for gynecological malignancies (ovarian cancer especially), and lack of proper information for patients about advantages of adequate preparation elvic expected surgery. Furter studies on different prehabilitation programs and information campaigns both for patients and gynecologist are required to make implementing prehabilitation possible in Poland.