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Curative treatment of head and neck cancer (HNC) often requires surgery; however, outcomes are impacted by the complexity of the surgery and the patient population. Increasingly ‘Enhanced Recovery After Surgery’ (ERAS) protocols are being used to maximise patient outcomes and help to reduce complication rates. These protocols consider how to optimise patients both before and after their surgery. This article presents a literature review focusing on the prehabilitation aspect of surgical protocols taken from different clinical areas including gastrointestinal, colorectal and HNC surgery with guidance for best practice from the evidence. Five studies presenting the results of three randomised control trials (RCTs), a pooled RCT and a meta-analysis of RCTs are reviewed. The main findings show that at diagnosis, patients are often malnourished and fatigued leading to deconditioning. Preoperative guidance focusing on nutrition, exercise and preparation for surgery leads to better postoperative outcomes, reduced length of stay, decreased anxiety, improved muscle and lean body mass, and an increase in physical activity. The authors recommend that patients with HNC should receive ERAS protocols including pre- and postoperative guidance, but acknowledge that further trials specific to HNC are necessary to investigate further.

Why Wait Until After Surgery? The Case for Pre-habilitation in Head and Neck Cancer Care.
List MA, Calligas JP, Pang J, et al.
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Gemma Clunie

BA (Hon), MSc, PhD, MRCSLT, Imperial College Healthcare NHS Trust; Honorary Research Fellow, Imperial College London, UK.

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