The Effectiveness of Prehabilitation on Surgical Outcomes in Pancreatic Surgery: A Systematic Review and Meta‐Analysis
Lyrics M. Noba, Robyn J. Stiger, Sanjay Pandanaboyana, Christopher J. Gaffney, Lawrence D. Hayes, Michael P. W. Grocott, Ajith K. SiriwardenaABSTRACT
Background
Pancreatic surgery is associated with high rates of postoperative complications. Prehabilitation has emerged as a key preoperative strategy to optimize patients’ physiological status prior to surgery. However, its specific role and efficacy in pancreatic surgery are not well established. This review aimed to examine the impact of multimodal prehabilitation interventions on key postoperative outcomes in patients undergoing elective pancreatic resection.
Methods
This systematic review and meta‐analysis was reported in accordance with PRISMA guidelines. MEDLINE, Embase, Web of Science and the Cochrane Library were searched. RCTs and comparative observational studies evaluating prehabilitation programs in adult patients undergoing pancreatic surgery were included. Meta‐analyses were performed for all studies combined, and separately for RCTs only and observational studies only.
Results
Twelve studies (two RCTs and 10 comparative observational studies) comprising 1841 patients were included. The RCT‐only analysis was based on 128 patients. Prehabilitation was associated with significantly fewer overall postoperative complications (RR 0.85; 95% CI, 0.76–0.95; p = 0.005) and delayed gastric emptying (DGE) events (RR 0.77; 95% CI, 0.63–0.94; p = 0.01). In the RCT‐only analysis, effects remained significant for overall complications (RR 0.53; 95% CI, 0.36–0.77; p = 0.001) and DGE (RR 0.34; 95% CI, 0.13–0.87; p = 0.02). However, there was no significant effect on length of stay ( p = 0.10), major complications ( p = 0.11), mortality ( p = 0.26), readmission ( p = 0.30) and postoperative pancreatic fistula ( p = 0.83).
Conclusion
This review suggests a potential morbidity benefit of prehabilitation for overall complications and delayed gastric emptying (DGE), but the evidence is derived predominantly from observational data, with only two small RCTs; these findings are exploratory and require confirmation in adequately powered randomized trials.