Effect of prehabilitation in patients undergoing gastric or oesophageal cancer resections: A systematic review and meta-analysis.

Abstract

Background: Gastric and oesophageal cancers are among the leading causes of cancer-related mortality globally. Treatment in the form of surgical resection and neoadjuvant therapy is considered the gold standard; however, these procedures are associated with significant postoperative morbidity and prolonged recovery times. Prehabilitation aims to combat this by physically and psychologically optimising patients preoperatively to handle the stress of surgery and improve postoperative outcomes.

Aim: To evaluate the effectiveness of prehabilitation in patients undergoing gastric or oesophageal cancer resections.

Methods: Standard medical databases such as MEDLINE, EMBASE, PubMed, and Cochrane Library were searched to find randomised, controlled trials comparing prehabilitation vs no-prehabilitation in patients undergoing gastric or oesophageal cancer resections. All data were analysed using Review Manager Software 5.4, and the meta-analysis was performed with a random-effect model analysis.

Results: A total of 16 studies were included (n = 1479), recruiting adult patients undergoing gastric or oesophageal cancer resections. In the random effect model analysis, prehabilitation was associated with fewer postoperative complications compared to no prehabilitation (Odds ratio: 0.43, 95%CI: 0.31-0.58, Z = 25.28, P < 0.00001). Additionally, prehabilitation was associated with a lower postoperative readmission rate (risk ratio: 0.58, 95%CI: 0.35-0.96, Z = 2.10, P = 0.04) and a shorter length of stay [standardised mean difference (SMD): -0.19, 95%CI: -0.37 to -0.02, Z = 2.21, P = 0.03] compared to no-prehabilitation. Prehabilitation was also found to improve preoperative 6-minute walking distance (6-MWD) compared to no-prehabilitation (SMD: 0.72, 95%CI: 0.21-1.23, Z = 2.75, P = 0.006). No statistical difference was found in postoperative 6-MWD, mortality, and severe complications.

Conclusion: Prehabilitation was found to be effective in reducing postoperative morbidity and improving preoperative physical health in patients undergoing gastric or oesophageal cancer resections.