IMPACT OF MULTIMODAL PREHABILITATION ON THE OUTCOMES OF CANCER SURGERY. SYSTEMATIC REVIEW
Keywords:
prehabilitation; cancer surgery; exercise; nutrition; postoperative complications; functional capacity; systematic reviewAbstract
DOI: https://doi.org/10.46296/gt.v9i18.0387
Abstract
Introduction. Cancer surgery causes an acute reduction in physiological reserve, especially in patients with frailty, sarcopenia, malnutrition, or undergoing neoadjuvant therapy. Multimodal prehabilitation aims to modify these factors before surgery through exercise, nutritional support, psychological intervention, and medical optimization. Objective. To evaluate the impact of multimodal prehabilitation on functional capacity, complications, length of hospital stay, readmissions, mortality, and patient-centered outcomes after cancer surgery. Methods. A systematic review was conducted according to PRISMA 2020 guidelines. Studies were searched in PubMed/MEDLINE, Europe PMC, and the Cochrane Library up to July 21, 2026, supplemented by reference tracing. Adults undergoing cancer surgery who received at least two prehabilitation modalities before the operation were included. Risk of bias was assessed using RoB 2 and ROBINS-I. Due to clinical and methodological heterogeneity, a narrative synthesis was performed following SWiM. The protocol was not registered in PROSPERO. Results. Twenty-four studies with 2078 participants were included: 16 randomized trials and 8 non-randomized studies. Seventeen studies showed a favorable trend regarding functional capacity, although the magnitude and timing of assessment varied. Eight studies reported a reduction in total, serious, medical, pulmonary, or intraoperative complications; ten found no significant differences, and six were not designed for that outcome. Length of stay was shorter in six studies but remained unchanged in eleven. Readmissions and mortality rarely improved. Benefits were clearer in supervised or semi-supervised programs, frail or high-risk patients, and studies with functional objectives. Overall certainty was moderate for functional capacity and low for most clinical outcomes. Conclusion. Multimodal prehabilitation is safe, feasible, and effective for increasing functional reserve before cancer surgery. It may reduce serious complications in selected populations, but the evidence does not support a uniform reduction in all complications or in length of stay. Standardized protocols, common outcomes, and multicenter trials with risk stratification are needed.
Keywords: prehabilitation; cancer surgery; exercise; nutrition; postoperative complications; functional capacity; systematic review.
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