Effect of prehabilitation in patients undergoing hepatobiliary and pancreatic cancer resections: A systematic review and meta-analysis

doi:10.4253/wjge.v17.i9.109029

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World Journal of Gastrointestinal Endoscopy

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Meta-Analysis

World J Gastrointest Endosc. Sep 16, 2025; 17(9): 109029
Published online Sep 16, 2025. doi: 10.4253/wjge.v17.i9.109029

Effect of prehabilitation in patients undergoing hepatobiliary and pancreatic cancer resections: A systematic review and meta-analysis

Omar Lubbad, Wajeeh Ullah Mahmood, Shehram Shafique, Krishna K Singh, Goldie Khera, Muhammad Shafique Sajid

Omar Lubbad, Wajeeh Ullah Mahmood, Medical School, Brighton and Sussex Medical School, Brighton BN19PX, Brighton and Hove, United Kingdom

Shehram Shafique, Department of Surgery, Worthing Hospital, Worthing BN112DH, West Sussex, United Kingdom

Krishna K Singh, Goldie Khera, Muhammad Shafique Sajid, Department of Gastrointestinal Surgery, Royal Sussex County Hospital, Brighton BN25BE, Brighton and Hove, United Kingdom

Author contributions: Lubbad O contributed to designing the study, data collection, and writing of the manuscript; Mahmood WU contributed to designing the study and data collection; Shafique S, Singh KK, and Khera G contributed to quality and professional revision; Sajid MS contributed to designing the study, revision of data collection, and quality revision of the manuscript; all of the authors read and approved the final version of the manuscript to be published.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Omar Lubbad, Medical School, Brighton and Sussex Medical School, 94 N–S Road, Falmer, Brighton BN19PX, Brighton and Hove, United Kingdom. o.lubbad1@uni.bsms.ac.uk

Received: April 28, 2025
Revised: June 7, 2025
Accepted: August 20, 2025
Published online: September 16, 2025
Processing time: 137 Days and 9.8 Hours

Abstract

BACKGROUND

Hepatobiliary and pancreatic cancers are often associated with high morbidity and mortality. Surgical intervention remains the cornerstone for curative treatment. However, Due to the complexity of these procedures, patients often experience postoperative complications. Prehabilitation has been suggested as a tool to decrease postoperative morbidity and improve recovery by optimising patients preoperatively to handle the stress of surgery.

AIM

To evaluate the effectiveness of prehabilitation in patients undergoing hepatobiliary and pancreatic cancer resections.

METHODS

Standard medical databases such as MEDLINE, EMBASE, PubMed, and Cochrane Library were searched to find randomised, controlled trials comparing prehabilitation vs no-prehabilitation before hepatic, biliary, or pancreatic cancer resections. All data were analysed using Review Manager Software 5.4, and the meta-analysis was performed with a random-effect model analysis.

RESULTS

A total of 8 studies were included (n = 568), recruiting adult patients undergoing hepatic, biliary, or pancreatic cancer resections. In the random effect model analysis, prehabilitation was associated with fewer postoperative complications compared to no prehabilitation [risk ratio (RR): 0.79, 95%CI: 0.66-0.95, Z = 2.52, P = 0.01]. No statistically significant difference was found in postoperative readmission rate (RR: 1.31, 95%CI: 0.79-2.17, Z = 1.05, P = 0.29), major complications (RR: 1.08; 95%CI: 0.61-1.92, Z = 0.28, P = 0.78), length of stay (standardised mean difference: -0.11, 95%CI: -0.31 to 0.1, Z = 1.05, P = 0.29), or mortality (RR: 0.28, 95%CI: 0.01-6.51, Z = 0.79, P = 0.43).

CONCLUSION

Prehabilitation was found to be effective in reducing postoperative complications following surgical intervention for hepatobiliary or pancreatic cancer.

Keywords: Prehabilitation; Hepatobiliary cancer; Pancreatic cancer; Cancer resection; Postoperative complications

Core Tip: Hepatobiliary and pancreatic cancer surgeries are complex procedures that carry a high risk of postoperative morbidity. This meta-analysis of 8 randomised controlled trials found that prehabilitation–focused on preparing patients physically, nutritionally, and mentally before surgery–significantly reduces the overall rate of complications. While no clear differences were seen in readmission, mortality, or length of stay, the data suggest a valuable role for prehabilitation in improving recovery following major abdominal cancer operations. These results highlight its potential for integration into standard preoperative care.