Impact of Prehabilitation in Major Gastrointestinal Oncological Surgery: a Systematic Review.

Abstract

Background: Patients undergoing major gastrointestinal oncologic surgeries often present with frailty, sarcopenia, anemia, and comorbidities that reduce physiological reserves and impair recovery. Prehabilitation is a proactive, multidisciplinary approach designed to optimize patient's health before surgery, thereby enhancing their capacity to tolerate surgical stress. Evidence indicates that prehabilitation can lead to shorter hospital stays, reduced intensive care admissions, a lower incidence of postoperative complications, and improved long-term quality of life.

Methods: This systematic review is aimed at comprehensively evaluating the current evidence on prehabilitation in gastrointestinal and hepatopancreatobiliary (HPB) surgeries, examining its components, mechanisms of benefit, and barriers to implementation. It also explores the effectiveness of multimodal prehabilitation programs and highlights areas for future research. A systematic search of "PubMed/MEDLINE," "Google Scholar," "Scopus," "Cochrane Library," "ClinicalTrials.gov," and "POPLINE" databases was conducted using a combination of Medical Subject Headings (MeSH) and keywords, including Prehabilitation, Anemia Correction, Nutrition Therapy, Physical Exercise, Gastrointestinal Cancer Surgeries, Hepato-Pancreato-Biliary Surgeries, Rehabilitation, and Postoperative Outcomes. Studies involving gastrointestinal cancer patients undergoing surgery, published between 1960 and June 2024, were included.  RESULTS: Multimodal prehabilitation programs demonstrated significant improvements in functional capacity, reductions in postoperative complications, shorter lengths of stay, and enhanced recovery. However, the strength of evidence varied by cancer type, with robust data supporting prehabilitation in colorectal surgeries and more limited evidence for HPB and upper gastrointestinal surgeries. Home-based programs showed mixed results, with adherence challenges potentially undermining their effectiveness. Inpatient supervised programs were more effective but associated with higher costs.

Conclusion: Prehabilitation holds promise as a transformative strategy in the perioperative care of gastrointestinal cancer patients. While it improves functional and clinical outcomes, significant barriers such as implementation costs, patient adherence, and variability in program design must be addressed. Future research should focus on tailoring prehabilitation for different cancer types, developing cost-effective models, and conducting high-quality trials to establish standardized guidelines. Integrating prehabilitation into routine clinical practice can significantly enhance surgical outcomes and patient quality of life.