Effect of prehabilitation programmes on functional capacity in patients awaiting oncological resections: a systematic review and meta-analysis of randomised controlled trials

Abstract

Purpose: To investigate the effects of prehabilitation on the perioperative functional capacity of patients awaiting oncological resections.

Methods: A systematic review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and within the databases Cochrane Library, EBSCOhost, Google Scholar, MEDLINE PubMed, and Web of Science. The eligibility criteria were set to include peer-reviewed randomised control trials including only adult (≥ 18 years old) patients undergoing any type of prehabilitation (PREHAB) prior to any type of oncological resection. The studies had to feature at least one control group undergoing standard care (SC) and had to assess functional capacity by means of a 6-min walk distance (6MWD) or peak oxygen uptake (VO_2Peak) at different stages pre- and post- operatively.

Results: Twenty-seven randomised controlled trials involving 1994 patients were included. After processing the data, the number of patients was 1889. Studies featured different cancer specialties: lung (11), colorectal (5), urological (4), abdominal (3), esophagogastric (2), liver (1), and gastrointestinal (1). Overall, PREHAB enhanced both 6MWD (g = 0.273, 95% CI 0.174 to 0.371, Z = 5.406, p < 0.001) and VO_2Peak (g = 0.615, 95% CI 0.243 to 0.987, Z = 3.240, p = 0.001) compared with SC. The 6MWD subgroup analysis revealed a small mean effect size favouring both unimodal and multimodal PREHAB interventions.

Conclusion: These findings support that prehabilitation, whether implemented as unimodal or multimodal format, elicits small preoperative improvements in functional capacity in patients awaiting oncological resections. PROSPERO registration number CRD42023428676.

Keywords: Cancer; Exercise; Surgery.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for study selection

Fig. 2

6-min walk distance risk of bias summary based on the Cochrane collaboration tool

Fig. 3

Peak oxygen uptake (VO_2Peak) risk of bias summary based on the Cochrane collaboration tool

Fig. 4

6MWD distance Forest plot. Results of a random-effects meta-analysis showed the effect size (g) with 95% confidence interval. The black diamonds represent the subgroups (unimodal or multimodal) standardised mean differences and the white diamond the pooled (overall) standardised mean differences. 6MWD, 6-min walk distance; CI, confidence interval

Fig. 5

VO_2Peak Forest plot. Results of a random-effects meta-analysis showed the effect size (g) with 95% confidence interval. The white diamond represents the pooled (overall) standardised mean differences. CI, confidence interval; VO_2Peak, peak oxygen consumption