Multimodal prehabilitation and perioperative immune function in patients undergoing abdominal cancer surgery

Prehabilitation is an emerging preoperative strategy designed to optimize patients' functional capacity before surgery to improve postoperative outcomes. Previous studies have demonstrated its clinical benefit, including enhanced recovery and reduced postoperative complications. However, the mechanisms underlying these benefits remain poorly understood. The aim of this exploratory study was to investigate the potential effects of prehabilitation on preoperative and postoperative immune function.

This prospective study utilized data and material from a subgroup of patients participating in the F4S PREHAB trial (NL73777.091.20), which is a stepped-wedge trial investigating the effects of multimodal prehabilitation before major surgery. In this substudy, patients who underwent elective bladder, oesophageal, or rectal cancer surgery between June 2022 and November 2023 were included. Immune function was assessed at baseline, after the prehabilitation or usual care interval, and on postoperative day 1 (POD1) by examining ex vivo cytokine production capacity, plasma cytokine concentrations, and monocytic human leucocyte antigen DR (mHLA-DR) expression.

This substudy included 130 patients: 102 in the prehabilitation group and 28 in the control group. After prehabilitation, the ex vivo production of pro-inflammatory cytokines was reduced, whereas the ex vivo production of the anti-inflammatory cytokine interleukin 10 (IL-10) was increased. Plasma concentrations of interleukin 6 (IL-6) and IL-10 were lower after prehabilitation. On POD1, no significant differences in postoperative immune function were observed between the prehabilitation and control groups.

This study suggests that multimodal prehabilitation influences basal immune function, leading to a less inflammatory state. However, as no significant differences in immune function were observed between the prehabilitation and control groups on POD1, the impact of prehabilitation on postoperative immune function may be limited.