Effects Of Prehabilitation Programs In Patients’ Functional Capacity Prior To Cancer Surgery

Functional capacity has been associated with better postoperative clinical outcomes (e.g., complications and length of stay). Surgical prehabilitation (PREHAB) is used to improve patients’ presurgical functional capacity and clinical outcomes. Systematic reviews and meta-analyses to date have focused on analyzing the effect of PREHAB on specific oncological specialties (e.g., colorectal). PURPOSE: To systematically summarize the effects of PREHAB on functional capacity in patients awaiting oncologic resection. METHODS: A systematic review with meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search of the literature was conducted using Cochrane Library, EBSCOhost, Google Scholar, MEDLINE PubMed, and Web of Science from March 2023 to October 2023. Inclusion criteria were randomized controlled trials (RCT), including adult patients (≥18 y/o), diagnosed with any cancer, undergoing or not neoadjuvant chemotherapy, implementing any PREHAB modality, and including at least an intervention group (PREHAB) and one control group (standard care). Continuous data on physical performance tests (e.g., 6MWD, VO2 consumption) as a marker of functional capacity were pooled using a random-effects model. The Comprehensive Meta-Analysis Software, v. 4.0.000 (Biostat Inc., Englewood, New York, USA) was used for the analysis. RESULTS: Twenty RCTs reporting 6MWD met the inclusion criteria and 22 prehabilitation groups were included. The mean effect size (Hedges’ g) of PREHAB vs. standard care on 6MWD was small (n = 22, g = 0.27, 95% CI 0.17 to 0.37), and statistically significant (Z = 5.406, p < 0.001) (Fig. 1). It was estimated that all studies in the analysis shared a common effect size (Q (21) = 19.873, p = 0.529, T2 = 0.000, I2 = 0.000). CONCLUSION: Current evidence suggests that PREHAB may have a small beneficial effect on functional capacity in patients awaiting oncologic resection.