Prehabilitation in Frail Patients Undergoing Cancer Surgery: A Systematic Review and Meta-analysis

BACKGROUND: The evidence of prehabilitation in frail patients with cancer is lacking. This systematic review and meta-analysis aimed to determine the effectiveness of prehabilitation on postoperative complications, and hospital length of stay (LOS) in this population. METHODS: A comprehensive search was performed in MEDLINE, Embase, Cochrane, CINAHL, AMED, and PsycINFO, encompassing all records from inception to December 2023. The outcomes of interest included postoperative complications and LOS. Risk of bias was assessed using the revised Cochrane risk of bias tool (RoB2) and GRADE was used to determine the quality of evidence. Relative risk (RR) or mean difference (MD) along with its 95% confidence interval (CI) were calculated by using random-effects meta-analysis. RESULTS: Five randomised controlled trials (four trials in colorectal or colon cancer), including 466 patients (230 patients undergoing prehabilitation and 236 standard of care controls), were included. Prehabilitation reduced any postoperative complications (RR = 0.82; 95% CI = 0.71-0.95; four trials, N = 465), but no effect was observed for major postoperative complications (RR = 0.89: 95% CI = 0.71-1.11; two trials, N = 226) and LOS (MD = 0.3, 95% CI = -0.68 to 1.28; three trials, N = 349). A single trial (including 57 patients) investigated the effect of exercise-only on a range of postoperative complications, with no significant difference between groups observed. CONCLUSIONS: In our systematic review and meta-analysis, we found that prehabilitation significantly decreased the rate of any postoperative complications in frail patients with cancer undergoing surgery. The role of prehabilitation in improving major postoperative outcomes is unclear owing to the limited amount of evidence.