Review
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2022; 28(22): 2403-2416
Published online Jun 14, 2022. doi: 10.3748/wjg.v28.i22.2403
Prehabilitation prior to intestinal resection in Crohn’s disease patients: An opinion review
Michiel T J Bak, Marit F E Ruiterkamp, Oddeke van Ruler, Marjo J E Campmans-Kuijpers, Bart C Bongers, Nico L U van Meeteren, C Janneke van der Woude, Laurents P S Stassen, Annemarie C de Vries
Michiel T J Bak, Marit F E Ruiterkamp, C Janneke van der Woude, Annemarie C de Vries, Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam 3015 GD, Netherlands
Oddeke van Ruler, Department of Surgery, IJsselland Hospital, Capelle aan den IJssel 2906 ZC, Netherlands
Oddeke van Ruler, Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam 3015 GD, Netherlands
Marjo J E Campmans-Kuijpers, Department of Gastroenterology and Hepatology, University Medical Center Groningen and University of Groningen, Groningen 9713 GZ, Netherlands
Bart C Bongers, Department of Nutrition and Movement Sciences, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht 6200 MD, Netherlands
Bart C Bongers, Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht 6200 MD, Netherlands
Nico L U van Meeteren, Department of Anaesthesiology, Erasmus MC University Medical Center Rotterdam, Rotterdam 3015 GD, Netherlands
Laurents P S Stassen, Department of Surgery, Maastricht University Medical Center, Maastricht 6229 HX, Netherlands
Author contributions: Bak MTJ reviewed and summarized the literature, and drafted the article; Ruiterkamp MFE reviewed the literature; de Vries AC supervised the study; and all authors contributed substantially to the concept and design of the study, critically revised the article, and approved the final version.
Conflict-of-interest statement: van der Woude CJ received grants and or fee for advisory boards and presentations from Pfizer, Abbvie, Celltrion, Falk Benelux, Takeda, Janssen, and Ferring outside the submitted work; de Vries AC has served on advisory boards for Takeda, Janssen, Bristol Myers Squibb, Abbvie, Pfizer, and Galapagos and has received unrestricted research grants from Takeda, Janssen, and Pfizer outside the submitted work; and all other authors declare that they 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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Annemarie C de Vries, MD, PhD, Doctor, Staff Physician, Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam 3015 GD, Netherlands. a.c.devries@erasmusmc.nl
Received: January 10, 2022
Peer-review started: January 10, 2022
First decision: March 8, 2022
Revised: March 21, 2022
Accepted: May 22, 2022
Article in press: May 22, 2022
Published online: June 14, 2022
Abstract

Patients with Crohn’s disease (CD) are at a considerable risk for intestinal surgery. Approximately 25% of patients with CD will undergo an intestinal resection within 10 years of diagnosis. Postoperative complications after CD surgery have been reported in 20%-47% of the patients. Both general and CD-related risk factors are associated with postoperative complications, and comprise non-modifiable (e.g., age) and potentially modifiable risk factors (e.g., malnutrition). Prehabilitation focuses on the preoperative period with strategies designed to optimize modifiable risk factors concerning the physical and mental condition of the individual patient. The aim of prehabilitation is to enhance postoperative recovery and return to or even improve preoperative functional capacity. Preoperative improvement of nutritional status, physical fitness, cessation of smoking, psychological support, and critical revision of preoperative use of CD medication are important strategies. Studies of the effect on postoperative outcome in CD patients are scarce, and guidelines lack recommendations on tailored management. In this opinion review, we review the current evidence on the impact of screening and management of nutritional status, physical fitness, CD medication and laboratory values on the postoperative course following an intestinal resection in CD patients. In addition, we aim to provide guidance for individualized multimodal prehabilitation in clinical practice concerning these modifiable factors.

Keywords: Crohn’s disease, Prehabilitation strategies, Nutrition, Physical fitness, Medication, Laboratory values

Core Tip: Nutritional status, medication, and laboratory values are modifiable factors that influence the postoperative course of patients with Crohn’s disease. In addition, physical fitness is impaired in the perioperative course and therefore preoperative screening is warranted. Individualized multimodal prehabilitation programs aim to improve these modifiable risk factors before surgery, including smoking cessation and psychological screening and support, and should be integrated in the preoperative preparation period in order to reduce both postoperative complications and undesirable outcomes.