Prehabilitation in pancreatic surgery: Impact of patient-related modifiable risk factors

Although pancreatic cancer is a relatively rare disease, it has significant consequences for patients: in more than half of them, the disease has already metastasized at the time of diagnosis, rendering curative treatment no longer possible. Patients whose disease is confined to the pancreas may be eligible for surgery, which is the cornerstone of curative treatment for pancreatic cancer. However, pancreatic surgery is considered one of the most invasive and complex forms of surgery, with a significant risk of postoperative complications ranging from mild to severe, and even a risk of death. Various patient-related risk factors increase the likelihood of postoperative complications.

The preoperative identification and optimization of patient-related modifiable risk factors, aimed at improving postoperative outcomes, is known as prehabilitation. This approach is gaining traction in various surgical disciplines. This dissertation investigates whether prehabilitation is also beneficial in pancreatic surgery. Wijma emphasizes in his dissertation the importance of timely identification of patient-related risk factors such as iron deficiency anemia, poorly controlled diabetes mellitus, severe malnutrition, and poor physical condition. His dissertation also demonstrates that the preoperative period is an appropriate time to optimize these risk factors. For instance, nutritional support from a specialized dietitian contributes to better nutritional status in patients, and a high-intensity interval training program at home can help patients become fitter before undergoing surgery. Wijma concludes his dissertation with the assertion that prehabilitation is an indispensable cornerstone in the perioperative care for patients undergoing pancreatic surgery.