Nutritional prehabilitation for robot-assisted radical prostatectomy: A proposed clinical framework integrating body...

Robot-assisted radical prostatectomy (RARP) has significantly minimized surgical trauma; however, patient-specific factors such as sarcopenia and malnutrition persist as independent determinants of postoperative recovery. Despite the minimally invasive nature of RARP, metabolic resilience remains a critical determinant of outcomes, particularly for older men with occult sarcopenia often masked by a normal body mass index. Due to the lack of level I evidence specific to prostate cancer, this review draws upon physiological principles from high-stress surgeries, such as radical cystectomy and colorectal procedures, to underscore the critical need for nutritional optimization. This review examines how surgical stress unmasks subclinical nutritional deficits and explores the utility of opportunistic, AI-assisted body composition analysis from routine staging CT scans to improve risk stratification. Furthermore, a clinical pathway is proposed that shifts the definition of prehabilitation success for RARP: rather than focusing solely on traditional metrics like length of stay, emphasis is placed on functional outcomes. Optimizing muscle mass may contribute to continence recovery and physical rehabilitation, a hypothesis that warrants prospective validation.