Prehabilitation linked to fewer complications after pancreatic surgery

A systematic review and meta-analysis of 12 studies involving 1,841 patients assessed multimodal prehabilitation before elective pancreatic resection. Prehabilitation was associated with fewer overall postoperative complications and delayed gastric emptying, but the evidence was predominantly observational and included only two small randomized trials.

12 studies included 1,841 patients; two were randomized trials.
Prehabilitation was associated with fewer overall complications and delayed gastric emptying.
No significant effect was found for mortality or length of stay.
Findings remain exploratory and require larger randomized trials.

Researchers conducted a PRISMA-reported systematic review and meta-analysis of randomized controlled trials and comparative observational studies evaluating multimodal prehabilitation in adults undergoing elective pancreatic resection. Twelve studies with 1,841 patients were included: two randomized trials and 10 observational studies. The randomized-trial analysis included 128 patients.

Across all studies, prehabilitation was associated with fewer overall postoperative complications (risk ratio [RR] 0.85; 95% CI, 0.76–0.95) and delayed gastric emptying (RR 0.77; 95% CI, 0.63–0.94). In the randomized-trial-only analysis, associations remained significant for overall complications (RR 0.53; 95% CI, 0.36–0.77) and delayed gastric emptying (RR 0.34; 95% CI, 0.13–0.87).

The review found no statistically significant effects on length of stay, major complications, mortality, readmission, or postoperative pancreatic fistula. The authors describe the morbidity findings as exploratory: most included evidence was observational, and the randomized evidence was based on two small trials. Adequately powered randomized studies are needed to confirm the findings.

In practice

For adults undergoing elective pancreatic resection, this review suggests that multimodal prehabilitation may be associated with fewer overall postoperative complications and delayed gastric emptying. The findings do not establish that prehabilitation improves other reported outcomes, including mortality, major complications, readmission, length of stay, or pancreatic fistula. Because 10 of the 12 studies were observational and the randomized-trial analysis included only 128 patients, the evidence is preliminary and does not establish a practice-changing benefit; confirmation in adequately powered randomized trials is needed.

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Source

World Journal of Surgery: The Effectiveness of Prehabilitation on Surgical Outcomes in Pancreatic Surgery: A Systematic Review and Meta‐Analysis ↗

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