Lubbad O, Mahmood WU, Shafique S, Singh KK, Khera G, Sajid MS. Effect of prehabilitation in patients undergoing hepatobiliary and pancreatic cancer resections: A systematic review and meta-analysis. World J Gastrointest Endosc 2025; 17(9): 109029 [PMID: 40979053 DOI: 10.4253/wjge.v17.i9.109029]
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03726961
Submitted on:
September 21, 2025, 16:02
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Reader Comments:
This systematic review and meta-analysis highlight the importance of prehabilitation in patients undergoing hepatobiliary and pancreatic cancer resections by providing a comprehensive analysis of randomized controlled trials (RCTs). It concluded that prehabilitation was associated with fewer postoperative complications compared to no prehabilitation, with a risk ratio (RR) of 0.79 (95% CI: 0.66-0.95, P = 0.01). Also there is tendency towards shorter hospital stay. No statistically significant differences were found between prehabilitation and no prehabilitation groups for postoperative readmission rates (RR: 1.31, 95% CI: 0.79-2.17, P = 0.29), major complications (RR: 1.08, 95% CI: 0.61-1.92, P = 0.78), length of stay (standardized mean difference: -0.11, 95% CI: -0.31 to 0.1, P = 0.29), or mortality (RR: 0.28, 95% CI: 0.01-6.51, P = 0.43). The study highlights that hepatobiliary and pancreatic cancers are highly lethal, and surgical intervention, though central to treatment, often leads to postoperative complications. Prehabilitation is proposed as a tool to optimize patients preoperatively, thereby reducing morbidity and improving recovery. Despite its findings, the authors acknowledge limitations, such as the relatively small sample size due to strict inclusion criteria of only RCTs, which may limit the generalizability. We found that the article does not explicitly address pulmonary complications, which are common in patients undergoing major abdominal surgeries, including hepatobiliary and pancreatic resections. This omission leaves a gap in understanding the full spectrum of prehabilitation's impact. The article notes that postoperative rehabilitative care varied between included trials, introducing heterogeneity. This makes it challenging to clearly differentiate between a 'prehabilitation' group and a 'standard care' group, especially since elements like nutritional support and pulmonary exercises are often considered standard preoperative care for these patients. The varied prehabilitation protocols (multimodal, nutritional, or exercise-based) further complicate this distinction. In conclusion, while this article provides valuable evidence that prehabilitation can reduce overall postoperative complications in hepatobiliary and pancreatic cancer resections, its limitations regarding sample size, protocol heterogeneity, lack of long-term data, and unaddressed specific complications like pulmonary issues highlight the need for more focused and standardized research in this critical area.