Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2021; 13(8): 734-755
Published online Aug 27, 2021. doi: 10.4240/wjgs.v13.i8.734
Paradigm shift in gastrointestinal surgery − combating sarcopenia with prehabilitation: Multimodal review of clinical and scientific data
Frederick H Koh, Jason MW Chua, Joselyn LJ Tan, Fung-Joon Foo, Winson J Tan, Sharmini S Sivarajah, Leonard Ming Li Ho, Bin-Tean Teh, Min-Hoe Chew
Frederick H Koh, Fung-Joon Foo, Winson J Tan, Sharmini S Sivarajah, Leonard Ming Li Ho, Min-Hoe Chew, Division of Surgery, Sengkang General Hospital, Singapore 544886, Singapore
Jason MW Chua, Joselyn LJ Tan, Institute of Molecular and Cell Biology, Agency for Science Technology and Research, Singapore 138673, Singapore
Bin-Tean Teh, Duke-NUS Graduate Medical School, National Cancer Centre Singapore, Singapore 169610, Singapore
Author contributions: Koh FH and Chua JMW contributed equally to this work; Koh FH, Chua JMW, Teh BT and Chew MH conceptualized the study; Koh FH, Chua JMW performed the review and wrote the manuscript; Tan JLJ, Foo FJ, Tan WJ, Sivarajah SS and Ho LML contributed key inputs to and edited the manuscript; All authors have read and approve the final manuscript.
Conflict-of-interest statement: All authors have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Frederick H Koh, FRCS (Ed), MBBS, Assistant Professor, Surgeon, Division of Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore.
Received: February 22, 2021
Peer-review started: February 22, 2021
First decision: May 4, 2021
Revised: May 8, 2021
Accepted: July 12, 2021
Article in press: July 12, 2021
Published online: August 27, 2021

A growing body of evidence has demonstrated the prognostic significance of sarcopenia in surgical patients as an independent predictor of postoperative complications and outcomes. These included an increased risk of total complications, major complications, re-admissions, infections, severe infections, 30 d mortality, longer hospital stay and increased hospitalization expenditures. A program to enhance recovery after surgery was meant to address these complications; however, compliance to the program since its introduction has been less than ideal. Over the last decade, the concept of prehabilitation, or “pre-surgery rehabilitation”, has been discussed. The presurgical period represents a window of opportunity to boost and optimize the health of an individual, providing a compensatory “buffer” for the imminent reduction in physiological reserve post-surgery. Initial results have been promising. We review the literature to critically review the utility of prehabilitation, not just in the clinical realm, but also in the scientific realm, with a resource management point-of-view.

Keywords: Sarcopenia, Prehabilitation, Surgery, Frailty, Value, Gastrointestinal surgery

Core Tip: The geriatric surgical population is rapidly growing and hence, clinicians have to take into account additional risk factors such as frailty. In particular, it is evident that sarcopenia is an independent predictive factor of postoperative outcomes. Prehabilitation represents a paradigm shift in geriatric surgical care, with the goal of enhancing functional capacity to withstand a forthcoming stressor. Emerging data has inspired healthcare professionals to not only adopt a multimodal approach, but also to pivot towards personalized programs.