Prehabilitation for patients undergoing pelvic exenteration

Pelvic exenteration (PE) is a highly complex surgical procedure associated with significant morbidity and prolonged recovery. Although prehabilitation has been shown to improve perioperative outcomes in colorectal and other major oncologic surgeries, its role in PE remains unclear. This study aims to evaluate the potential application and clinical relevance of prehabilitation for patients undergoing PE.

A narrative review of the literature was conducted to examine the role of prehabilitation in major oncologic surgery, with a focus on its applicability to pelvic exenteration. Relevant studies were identified through searches of PubMed, Embase, and Google Scholar. Evidence from colorectal and other surgical populations was included when direct PE-specific data were lacking.

Prehabilitation programs, typically incorporating exercise, nutritional optimization, and psychological support, have been shown to improve functional capacity, reduce postoperative complications, and shorten hospital stays in colorectal surgery. However, no studies were identified that specifically evaluate prehabilitation in the PE population. Patients undergoing PE often present with significant physiological and psychological burdens, suggesting a potentially greater benefit from prehabilitation. Key challenges include treatment-related toxicity, nutritional deficits, and the complexity of coordinating multimodal interventions within constrained preoperative timelines.

The physiological rationale and supporting data from related surgical populations suggest that prehabilitation would confer meaningful benefits for patients undergoing pelvic exenteration. Prospective studies are needed to assess the "best" type of exercise and rehabilitation programs prior to PE.