PP301 - SUPERVISED MULTIMODAL PREHABILITATION AND CLINICAL OUTCOMES IN OLDER PATIENTS WITH FRAILTY AND GASTRIC CANCER THE GISSG+2201 RANDOMIZED CLINICAL TRIAL

PP301

SUPERVISED MULTIMODAL PREHABILITATION AND CLINICAL OUTCOMES IN OLDER PATIENTS WITH FRAILTY AND GASTRIC CANCER THE GISSG+2201 RANDOMIZED CLINICAL TRIAL

Y. Sun¹, Y. Zhou¹, Z. Li^2,*

¹the affiliated hospital of qingdao university, ²Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, China

Rationale: Frailty is associated with functional decline and increased postoperative morbidity. Prehabilitation may complement Enhanced Recovery After Surgery (ERAS) care to improve patient outcomes.

Methods: This randomized clinical trial was conducted at 15 centers in China. Participants aged 65 to 85 years with frailty scheduled for elective gastrectomy or neoadjuvant chemotherapy prior to elective gastrectomy were randomized 1:1 to ERAS care either with or without prehabilitation. The prehabilitation group (PG) underwent multimodal prehabilitation for at least 2 weeks in combination with ERAS care, while the standard ERAS group (SG) followed a well-defined ERAS pathway.

Results: In the modified intention-to-treat population of 347 participants (PG: n = 169; SG: n = 178), overall compliance with prehabilitation was 93.75%; median (IQR) participant age was 70 (68-73) years, and 95 participants (27.4%) were female. The rate of complications was lower in PG compared to SG (17.2% vs 28.7%; P = .01). In particular, significant benefits were observed in minor complications (PG: 10.7%; SG: 20.2%; P = .01) and medical complications (PG: 8.3%; SG: 16.9%; P = .02). The PG showed increased functional capacity before surgery compared to baseline (mean [SD] 6-minute walk test change, +24 [12.5] m; P < .001). Moreover, secondary parameters, such as chronic low-grade inflammation, preoperative physical quality of life, length of intensive care unit stay, mechanical ventilation time, and length of hospital stay, generally favored prehabilitation compared with standard ERAS care.

Conclusion: Per the results of this randomized clinical trial, a multimodal prehabilitation program may enhance physiological reserve, reduce morbidity, and promote surgical resilience in older patients with frailty undergoing radical gastrectomy.

Disclosure of Interest: None declared