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Comparative effectiveness of different prehabilitation strategies in patients undergoing digestive system cancer
Zhenzi Wang1, Jiaqi Li1, Qian Zhang1
1Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Background:
This network meta-analysis (NMA) aimed to evaluate the efficacy of different prehabilitation modalities for patients undergoing digestive system cancer surgery.
Methods:
A systematic search of PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials, and the Web of Science was performed from inception to March 1, 2025. Randomized controlled trials (RCTs) assessing exercise-based prehabilitation (EX), nutrition-based prehabilitation (NU), or multimodal prehabilitation (Mul) were included. The primary clinical outcomes included length of hospital stay (LOS) and postoperative complications, whereas the functional outcomes included 6-minute walking distance (6MWD), anxiety, depression, and quality of life (QoL). Pairwise meta-analyses were performed to estimate the mean differences (MDs) or odds ratios (ORs) with 95% CIs. An NMA was performed to rank interventions using surface under the cumulative ranking (SUCRA) probabilities.
Results:
A total of 26 RCTs involving 2042 patients were included. Pairwise meta-analyses revealed that prehabilitation significantly reduced LOS (MD, -1.12 [95% CI, -1.99 to -0.26]) and postoperative complications (OR, 0.71 [95% CI, 0.59-0.86]) while improving 6MWD (MD, 35.59 [95% CI, 20.47-50.72]) and QoL (MD, 5.96 [95% CI, 2.00-9.92]). Subgroup analyses indicated that patients with gastric cancer benefited more in terms of complication reduction. The NMA ranked EX as the most effective for reducing postoperative complications (SUCRA = 88.9%), followed by Mul (SUCRA = 74.0%). For functional outcomes, EX ranked the highest for postoperative 6MWD improvement (SUCRA = 81.0%), whereas Mul was superior in improving presurgery 6MWD (SUCRA = 74.9%), QoL (SUCRA = 99.2%), and depressive symptoms (SUCRA = 87.9%).
Conclusion:
Prehabilitation, particularly EX and Mul, effectively reduces postoperative complications and enhances functional recovery in digestive system cancer surgery. Clinicians should consider patient-specific factors when selecting prehabilitation strategies. Future research should standardize intervention protocols and outcome measures to optimize perioperative care.
