Prehabilitation in Adults Undergoing Cancer Surgery - A Comprehensive Review on Rationale, Methodology, and Measures of Effectiveness

Sep 21, 2026

Cancer surgery creates substantial strain on patients’ functional status and quality of life, while also contributing to postoperative complications that are shaped by baseline function. Prehabilitation is a unimodal or multimodal approach designed to strengthen functional capacity to lower postoperative risk and support improved recovery and quality of life. It commonly combines exercise, nutrition, and interventions targeting anxiety. Existing research spans multiple cancer surgery types, most frequently colorectal and thoracic, and indicates improvements in physiological and clinical outcomes, beyond ERAS. Evidence remains low to moderate due to methodological heterogeneity and limited sample sizes, highlighting the need for larger multicenter randomized trials.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Introduction

Prehabilitation concept and clinical relevance

Rationale based on physical fitness and perioperative outcomes

Definitions and distinction from ERAS and condition-specific treatments

Evidence landscape and need for standardized research

Review Prehabilitation in Adults Undergoing Cancer Surgery: A Comprehensive Review on Rationale, Methodology, and Measures of Effectiveness Carlos E. Guerra-Londono 1, Juan P. Cata 2, Katherine Nowak 1 and Vijaya Gottumukkala 2, * Citation: Guerra-Londono, C.E.; Cata, J.P.; Nowak, K.; Gottumukkala, V. Prehabilitation in Adults Undergoing Cancer Surgery: A Comprehensive Review on Rationale, Methodology, and Measures of Effectiveness. Curr. Oncol. 2024, 31, 2185–2200. [https://](https://)[ ](https://)[doi.org/10.3390/curroncol31040162](doi.org/10.3390/curroncol31040162) Received: 21 March 2024 Revised: 3 April 2024 Accepted: 4 April 2024 Published: 9 April 2024 Copyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) . 1 Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health, Detroit, MI 48202, USA; [cguerra1@hfhs.org](cguerra1@hfhs.org) (C.E.G.-L.); [knowak2@hfhs.org](knowak2@hfhs.org) (K.N.) 2 Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; [jcata@mdanderson.org](jcata@mdanderson.org) * [Correspondence: vgottumukkala@mdanderson.org](Correspondence: vgottumukkala@mdanderson.org); Tel.: +1-2817552102 Abstract: Cancer surgery places a significant burden on a patients’ functional status and quality of life. In addition, cancer surgery is fraught with postoperative complications, themselves influenced by a patient’s functional status. Prehabilitation is a unimodal or multimodal strategy that aims to increase a patient’s functional capacity to reduce postoperative complications and improve postoperative recovery and quality of life. In most cases, it involves exercise, nutrition, and anxiety-reducing interventions. The impact of prehabilitation has been explored in several types of cancer surgery, most commonly colorectal and thoracic. Overall, the existing evidence suggests prehabilitation improves physiological outcomes (e.g., lean body mass, maximal oxygen consumption) as well as clinical outcomes (e.g., postoperative complications, quality of life) . Notably, the benefit of prehabilitation is additional to that of enhanced recovery after surgery (ERAS) programs. While safe, prehabilitation programs require multidisciplinary coordination preoperatively. Despite the existence of numerous systematic reviews and meta-analyses, the certainty of evidence demonstrating the efficacy and safety of prehabilitation is low to moderate, principally due to significant methodological heterogeneity and small sample sizes. There is a need for more large-scale multicenter randomized controlled trials to draw strong clinical recommendations. Keywords: cancer; surgery; prehabilitation; preoperative; exercise; complications 1. Introduction Surgery is essential to improve survival in patients with solid malignancies. By 2040, the global demand for cancer surgery is estimated to increase by 52%, representing nearly 14 million cases [1] . Despite its benefits, surgery is known to negatively affect a patient’s quality of life and functional status [2] . The postoperative journey is also fraught with postoperative complications, which can be influenced by the type of surgery, medical history, and functional status [3] . Postoperative complications are a major concern in cancer patients because they are strongly associated with worse overall and/or disease-specific survival [4–7], even if the patients survive them [8] . Over the last two decades, there has been a growing interest in the implementation of preoperative interventions to improve a patient’s functional status. This is known as prehabilitation [9] . Preha

FAQs

What problem does prehabilitation aim to address in adults undergoing cancer surgery?

It targets reduced functional capacity and the risk of postoperative complications, with the goal of improving recovery and quality of life.

What components are commonly included in prehabilitation programs?

Most programs involve exercise, nutrition, and interventions that reduce anxiety.

How is prehabilitation differentiated from ERAS programs?

Prehabilitation is described as starting more than 7 days before surgery and lasting at least 7 days, and its benefit is presented as additional to enhanced recovery after surgery (ERAS).

Why is the evidence for prehabilitation efficacy and safety considered low to moderate?

Large methodological heterogeneity and small sample sizes reduce certainty, and the article calls for more large-scale multicenter randomized controlled trials.

Sep 21, 2026

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