The effects of exercise prehabilitation in upper gastrointestinal oncology patients undergoing surgical resection:a systematic review

Background: Prehabilitation (PH) programs are being increasingly recognised as a tool for enhancing patient postoperative outcomes following major surgery. This systematic review aims to look specifically at the feasibility of exercise PH in patients undergoing upper gastrointestinal (UGI) cancer surgery and to evaluate the effectiveness of these PH programs on post-operative outcomes.Methods: A systematic literature search was completed in May 2021 of the following databases: Medline, Embase, PubMed and CINAHL as well as a grey literature search. The search was conducted for trials evaluating the effects of exercise PH in UGI patients using an objective functional capacity measurement pre- and post-program prior to surgery. Both randomised controlled trials (RCTs) and high-quality non-randomised studies were included and assessed using the Risk of Bias-2 (ROB-2) and the Risk of Bias in Non-randomised Studies-1 (ROBINS-1) assessment tools respectively. The feasibility of exercise PH was assessed objectively by evaluating changes in functional capacity assessments. Postoperative outcomes were evaluated as secondary outcomes.Results: Eight studies were included in this review: 2 RCTs and 6 observational prospective cohort studies. Risk of bias was low for the RCTs but moderate across the other six studies. A total of 402 patients were in the exercise PH groups across the studies, 208 of which underwent neoadjuvant chemotherapy (NAC). A significant improvement in functional capacity was seen in 6 of the studies. Postoperatively, one study observed a significant improvement in length of stay (median 23 vs. 30 days, P=0.045), but no change in overall incidence of postoperative complications.Discussion: This review shows that it is feasible to conduct preoperative exercise-based PH programs in UGI cancer patients and that they can significantly improve functional capacity prior to surgery. Whether this improvement leads to superior postoperative outcomes is yet to be established as none of the studies included were adequately powered to assess this