Perioperative Optimization Strategies in Major Genitourinary Cancer Surgery

Objective: To evaluate current and emerging perioperative optimization strategies in genitourinary surgery and assess their potential to improve surgical outcomes, particularly in patients with modifiable risk factors. Methods: A literature review was conducted using PubMed databases examining perioperative interventions relevant to patients undergoing surgery for genitourinary cancers. Areas of focus included enhanced recovery after surgery protocols, nutritional optimization, exercise prehabilitation, smoking cessation, glucagon-like peptide-1 receptor agonists, and gut microbiome modulation. Evidence from clinical trials, observational studies, systematic reviews, and current clinical guidelines was reviewed and synthesized. Results: Current evidence supports the use of enhanced recovery after surgery protocols to reduce acute complications, shorten length of stay and decrease recovery time. Nutritional optimization and exercise prehabilitation demonstrated improved functional and metabolic capacity. Smoking cessation improved wound healing and decreased pulmonary and infectious complications. Emerging evidence suggests GLP-1 RAs offer metabolic benefits, and microbiome-targeted interventions may improve postoperative recovery through gut microbiome diversity preservation, although clinical data remains limited. Conclusions: Perioperative strategies demonstrate promising potential to improve outcomes in patients undergoing genitourinary surgeries by addressing modifiable risk factors. Further prospective studies are needed to guide clinical implementation.