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Review
. 2025 Feb;32(2):1236-1247.
doi: 10.1245/s10434-024-16527-8. Epub 2024 Nov 30.

Prehabilitation Outcomes in Surgical Oncology Patients Undergoing Major Abdominal Surgery: A Meta-analysis of Randomized Control Trials

Natalie Hann Soh #  1 , Charles Rong Zhang Yau #  2 , Xi Zhi Low  2 , Hanis Abdul Kadir  3 , Wei Jing Fong  1 , Mothi Babu Ramalingam  4 , Pei Ling Tan  4 , Kennedy Yao Yi Ng  5   6   7 , Ya Ting Hsing  8 , Mingzhe Cai  1 , Chin Jin Seo  1 , Johnny Chin-Ann Ong  1   6   9   10   11 , Claramae S Chia  1   9 , Jolene Si Min Wong  12   13
Affiliations
Review

Prehabilitation Outcomes in Surgical Oncology Patients Undergoing Major Abdominal Surgery: A Meta-analysis of Randomized Control Trials

Natalie Hann Soh et al. Ann Surg Oncol. 2025 Feb.

Abstract

Background: Prehabilitation has been increasingly utilized to optimize perioperative outcomes. In this study, we aim to evaluate the impact of uni- and multimodal prehabilitation on functional capacity and postoperative outcomes among surgical oncology patients undergoing major abdominal surgery.

Patients and methods: Three electronic databases (PubMed, Embase, Cochrane) were systematically searched up until December 2023. We included randomized controlled trials comparing prehabilitation to standard of care in surgical oncology patients undergoing major abdominal surgery. Our primary outcome was functional capacity as measured by the 6-min walk distance (6MWD). Secondary outcomes include postoperative complications, emergency readmissions, and length of stay (LOS). We stratified our findings to determine the impact of uni- versus multimodal prehabilitation on outcomes.

Results: We included 27 studies with 2532 surgical oncology patients. Overall, patients undergoing prehabilitation demonstrated a significant improvement in preoperative functional capacity compared to those without prehabilitation (mean difference in 6MWD 28.32 meters [m], 95% CI 15.26, 41.39, p < 0.01). Prehabilitation was also associated with significantly lower odds of postoperative complications (odds ratio [OR] 0.60, 95% CI 0.46, 0.78, p < 0.01). There was no difference in emergency readmission (OR 0.90, 95% CI 0.59, 1.38, p = 0.61) or LOS (mean difference -0.42 days, 95% CI -1.01, 0.16, p = 0.15). Comparing uni- versus multimodal prehabilitation, multimodal prehabilitation was associated with greater improvements in functional capacity (6MWD 37.35 m versus 13.38 m) and lower odds of postoperative complications (OR 0.61, 95% CI 0.45, 0.82, p < 0.01 versus OR 0.63, 95% CI 0.36, 1.11, p = 0.10) CONCLUSION: Prehabilitation improves functional capacity and reduces postoperative complications among surgical oncology patients undergoing major abdominal surgery.

Keywords: Abdominal; Cancer; Meta-analysis; Prehabilitation; Surgery; Surgical oncology.

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Conflict of interest statement

Disclosure: The Authors declare that there is no conflict of interest. The above study was approved by SingHealth Centralized Institutional Review Board and informed consent obtained prior to enrolment. Deidentified data are available upon requests. Ethical approval: The above study was approved by SingHealth Centralized Institutional Review Board and informed consent obtained prior to enrolment.

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