The Effect of Multimodal Prehabilitation on Functional Capacity and Postoperative Complications in Gastrointestinal Cancer Surgery: A Systematic Review and Meta-analysis.

Abstract

This study evaluated multimodal perioperative prehabilitation - combining exercise, nutrition, and psychological interventions - on functional capacity (6MWT distance, reflecting cardiopulmonary fitness) and clinical outcomes (postoperative complications, hospital stay, mortality, readmission rates) in gastrointestinal cancer surgery. We conducted a systematic review and meta-analysis of 12 prospective trials (n=1,229) identified via the PubMed, Web of Science, Cochrane Library and Embase databases from their inception to 20 March 2025. Heterogeneity was evaluated with I² and Q tests; random- or fixed-effects models were applied. Multimodal prehabilitation significantly improved the 6MWT preoperatively (mean difference [MD] 30.1 m; 95% CI: 14.8-45.4) and at 4 weeks (MD 21.5 m; 95% CI: 14.1-28.9) and 8 weeks postoperatively (MD 38.7 m; 95% CI: 1.9-75.4). It was associated with a 0.86 days (95% CI: -1.43--0.30) shorter hospital stay and lowered overall (risk ratio [RR] 0.67; 95% CI: 0.57-0.79) and severe complications (RR 0.77; 95% CI: 0.61-0.97), with no effect on operative time, mortality or readmission. This study shows patients receiving multimodal prehabilitation achieve better functional recovery (6MWT) and fewer complications, supporting its integration into perioperative care.