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Multimodal prehabilitation for upper gastrointestinal tumors: effects on postoperative morbidity and mortality - a
Csenge Papp1, Armand Csontos1, Daniel Kehl2
1Department of Surgery, Clinical Center, University of Pécs, Pécs, Hungary.
Background:
Patients suffering from upper gastrointestinal (UGI) cancers often present with malnutrition and frailty before undergoing major surgical procedures, which significantly elevates the risk of postoperative complications. Prehabilitation focuses on optimizing a patient's functional capacity before surgery to improve postoperative outcomes. Our goal was to synthesize the effects of prehabilitation on the postoperative outcomes of UGI cancer patients undergoing major surgical intervention using a systematic review and meta-analysis.
Methods:
A comprehensive systematic search was conducted across the PubMed, Embase, Cochrane, and Scopus databases to identify relevant randomized controlled trials (RCTs). Ten RCTs, encompassing data from 878 patients, were included in the analysis. Pooled risk ratios (RRs) were calculated for dichotomous variables (e.g., incidence of complications), and weighted mean differences were calculated for continuous variables using a random-effects model. Study quality was assessed using the RoB2 and GRADE approaches.
Results:
The meta-analysis showed a trend toward a lower incidence of minor postoperative complications (Clavien-Dindo Grade I-II) in the prehabilitation group. While the common effect model showed significance, the certainty of evidence remains low to very low for most outcomes, suggesting these results should be interpreted with caution. However, a significant reduction was found in Grade III complications when using a common effect model, although no significant differences were detected in Grade IV complications or mortality. Cardiovascular complications and hospital readmission rates also showed no significant disparity.
Conclusion:
The implementation of prehabilitation in UGI cancer patients is safe and shows a positive trend toward reducing minor postoperative complications, thereby enhancing patient comfort and potentially accelerating recovery time. While the certainty of evidence remains low, further high-quality RCTs with larger patient cohorts are warranted, especially to explore the role of multimodal prehabilitation.