Body Composition and Quality of Life After Prehabilitation Prior to Pancreaticoduodenectomy: A Preliminary Sub-Analysi

Surgical resection with pancreaticoduodenectomy (PD) is the only potentially curative treatment for pancreatic cancer.1 Pre-operative physical and nutritional reserve are imperative1-3 with reduced muscle mass and function, known as sarcopenia, found to be an independent predictor of survival following PD.4 The concept of "prehabilitation" (Prehab) is a newer approach to improve sarcopenia and nutritional status with the goal of equipping patients to better tolerate the physiological stress of surgery.5.;The purposes of these preliminary sub-analyses are to describe patient-reported quality of life (QoL) and to quantify changes in body weight, lean body mass, fat mass, and total body water among patients enrolled in prehab prior to PD.;Patients newly approved for PD for pancreas or related cancer or premalignant disease were randomly assigned to one of two home-based 2-week exercise programs with standard yet individualized exercise. All patients received nutrition counseling with protein supplementation based on individual diet. Study assessments at 3 time points (baseline, 1-2 days before surgery, and 1-2 months after surgery) included measures of body composition (Bioelectric Impedance Analysis, BIA) and quality of life (Functional Assessment of Anorexia/Cachexia Treatment, FAACT). A compound symmetric random intercept model was used to describe changes in body composition data among the 3 time points, to compare the two exercise groups, and to compare patients who had neo-adjuvant chemotherapy with those who went straight to surgery. Wilcoxon Sign-Rank Tests were used to identify changes in patient-reported quality of life.;It was found that participants were able to increase mean body weight from baseline to pre-op visit by 3.2 pounds (p=0.029, 95% CI: 0.4, 6.1). No measures of body composition constituents changed significantly over the intervention time period. From surgery to about 6 weeks post-operative, body weight decreased by 15.5 pounds (p<0.0001), fat mass by 10.9 pounds (p=0.0004) and fat-free mass by 5 pounds (p=0.0483). At baseline participants who just completed neo-adjuvant chemotherapy weighed 15.6 pounds less than those who did not (p=0.3570), accounted for mostly by differences in fat mass. No significant differences in body composition were found when participants in the two different exercise groups were compared. No significant changes were found in patient-reported quality of life from baseline to the pre-operative appointment.;Results from this study support the implementation of a nutrition and physical therapy based prehabilitation program for patients preparing for PD.