The Impact of Prehabilitation on Clinical Outcomes in Liver Surgery: A Systematic Review and Meta-Analysis.

Abstract

Major liver surgery is associated with significant physiological stress and a high rate of postoperative complications. Prehabilitation aims to enhance physiological reserve before surgery. Despite the growing volume of liver resections worldwide, the impact of prehabilitation on clinical and economic outcomes in patients undergoing elective liver resection is poorly understood. A systematic review and meta-analysis was reported in accordance with PRISMA guidelines. MEDLINE, Embase, Web of Science and the Cochrane Library were searched in November 2025. Randomized controlled trials and comparative observational studies evaluating preoperative programs with a structured exercise component, with or without additional nutritional and psychological support in adult patients undergoing major elective liver surgery were included. Six studies (four RCTs and two comparative cohort studies) comprising 557 patients were included. Prehabilitation resulted in significantly fewer overall postoperative complications (OR 0.55; 95% CI, 0.37 to 0.84; p = 0.005). No significant differences were observed for length of stay (MD -0.38 days; 95% CI, -1.08 to 0.32; p = 0.29), major complications (OR 0.79; 95% CI, 0.50 to 1.27; p = 0.33), mortality (OR 0.40; 95% CI, 0.05 to 3.24; p = 0.39), readmission (OR 0.85; 95% CI, 0.47 to 1.55; p = 0.60) and hospitalization costs (MD = -137.13; 95% CI, -642.19, 367.93; p = 0.59). Prehabilitation significantly reduces overall postoperative complications following liver resection. The absence of standardized, liver-specific interventions limits the determination of effective program design. Future research should prioritize standardised protocols and evaluate post-hepatectomy functional recovery, patient-reported outcomes and cost-effectiveness.