Effect of prehabilitation in patients undergoing hepatobiliary and pancreatic cancer resections: A systematic review and meta-analysis.

Background: Hepatobiliary and pancreatic cancers are often associated with high morbidity and mortality. Surgical intervention remains the cornerstone for curative treatment. However, Due to the complexity of these procedures, patients often experience postoperative complications. Prehabilitation has been suggested as a tool to decrease postoperative morbidity and improve recovery by optimising patients preoperatively to handle the stress of surgery.

Aim: To evaluate the effectiveness of prehabilitation in patients undergoing hepatobiliary and pancreatic 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 before hepatic, biliary, or pancreatic 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 8 studies were included (n = 568), recruiting adult patients undergoing hepatic, biliary, or pancreatic cancer resections. In the random effect model analysis, prehabilitation was associated with fewer postoperative complications compared to no prehabilitation [risk ratio (RR): 0.79, 95%CI: 0.66-0.95, Z = 2.52, P = 0.01]. No statistically significant difference was found in postoperative readmission rate (RR: 1.31, 95%CI: 0.79-2.17, Z = 1.05, P = 0.29), major complications (RR: 1.08; 95%CI: 0.61-1.92, Z = 0.28, P = 0.78), length of stay (standardised mean difference: -0.11, 95%CI: -0.31 to 0.1, Z = 1.05, P = 0.29), or mortality (RR: 0.28, 95%CI: 0.01-6.51, Z = 0.79, P = 0.43).

Conclusion: Prehabilitation was found to be effective in reducing postoperative complications following surgical intervention for hepatobiliary or pancreatic cancer.