Multidimensional Prehabilitation in Pancreatic Surgery for Pancreatic and Periampullary Neoplasms

Frailty is independently associated with an increased risk of adverse outcomes after major surgery, including pancreatic resection. Prehabilitation aims to optimize modifiable risk factors to improve participants' baseline health prior to surgery. Multiple studies with participants undergoing pancreatic surgery have investigated the impact of prehabilitation on preoperative health metrics as well as postoperative outcomes. The majority of these studies focused only on exercise; if nutritional and/or psychological status were assessed, these dimensions were not intervened upon in prehabilitation regimens or reassessed postoperatively. This randomized controlled trial (RCT) is designed to assess the impact of physical and nutritional prehabilitation on participants' perioperative condition for those undergoing pancreatic resection for diagnosed or suspected pancreatic and periampullary neoplasms.

Inclusion criteria

• Participants > 18 years old with ECOG performance status 0-2 and ASA score ≤3
• Requiring pancreatic resection for diagnosed or suspected pancreatic and periampullary neoplasms
• Surgery scheduled at least 2 weeks after the initial surgical evaluation
• Fluency in English

• Willingness to answer questionnaires, complete daily exercise & nutrition log, as well as participate in follow-up telephone calls
• Screening: Physical Activity Readiness - Questionnaire (PAR-Q+)

• PAR-Q+ assesses participants comorbidities and symptoms with current activities. If participants answer "yes" to any of the screening questions, they will need to complete additional questions regarding their chronic medical conditions including, but not limited to, heart disease, stroke, diabetes, depression/anxiety, and COPD/asthma, to determine their ability to participate in physical activity.

Exclusion criteria

• Screening: Physical Activity Readiness - Questionnaire (PAR-Q+)

• Participants with concurrent medical conditions that prohibit exercise, such as those who indicate on the questionnaire that they experience chest pain, dizziness, or loss of consciousness with physical activity; those with chest pain at rest; or those with bone/joint/soft tissue conditions that could worsen with physical activity. Participants with specific comorbidities, such as coronary artery disease. congestive heart failure, or uncontrolled asthma/COPD, that may prevent participation will also be excluded.
• Inability to provide own informed consent
• Inability to read or verbally understand questionnaires in English
• Impaired hearing that creates a barrier for telephone follow-up
• Visual deficit that would cause exercise to be hazardous
• Emergent or urgent surgeries