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

Table 1 Characteristics of included studies

Ref.	Country	Operation	Number of recruited patients	Age in years	Female:male	Duration of follow up	Trial running time
Ausania et al[20], 2019	Spain	Pancreaticoduodenectomy
Prehabilitation			18	66.1 ± 10.51	9:9
No prehabilitation			22	65.7 ± 10.751	9:13	18 days	2015-2017
Dunne et al[21], 2016	United Kingdom	Liver resection
Prehabilitation			20	61 ± 2.51	7:13	4 weeks	2011-2013
No prehabilitation			17	62 ± 4.751	4:13
Gade et al[22], 2016	Denmark	Pancreatic cancer resection
Prehabilitation			19	68 ± 7.751	7:12	30 days	2012-2012
No prehabilitation			16	69 ± 6.51	10:6
Griffiths et al[23], 2024	Canada	Open and laparoscopic hepatic, pancreatic, and colorectal resection
Prehabilitation			33	65 ± 3.251	12:21	12 weeks	Not reported
No prehabilitation			30	63 ± 2.51	13:17
Kaibori et al[24], 2013	Japan	Hepatectomy
Prehabilitation			25	68 ± 9.1	8:17	6 months	2008-2010
No prehabilitation			26	71.3 ± 8.8	7:19
McIsaac et al[25], 2022	Canada	Open and minimally invasive hepatobiliary, colorectal, thoracic, urologic cancer resections
Prehabilitation			94	74 ± 7	57:34	30 days	2017-2019
No prehabilitation			88	74 ± 6	46:42
Mikkelsen et al[26], 2022	Denmark	Pancreatic, biliary tract, non-small cell lung cancer resections
Prehabilitation			41	72.1 ± 1.81	22:19	13 weeks	2018-2020
No prehabilitation			43	71.5 ± 1.71	26:17
Ngo-Huang et al[27], 2024	United States	Pancreatic cancer resection
Prehabilitation			75	66.1 ± 8.5	26:49	3 months	2017-2021
No prehabilitation			76	66.2 ± 8.2	33:43

¹Standard deviation calculated from range.

Table 2 Treatment protocol adopted in included studies

Ref.	Prehabilitation	No prehabilitation
Ausania et al[20], 2019	5 days training in outpatient clinic and daily training at home. Nutritional support. Endocrine and exocrine pancreatic management	Dietary advice, physical activity recommendations
Dunne et al[21], 2016	12 personalized exercise sessions over 4 weeks period	Standard care
Gade et al[22], 2016	Oral supplement 7 days before surgery	No intervention
Griffiths et al[23], 2024	Supplement solutions. 20 g protein isolate powder day 30-6 pre-operation. Immunonutrition 3 times a day 5-1. Carbohydrate rich solution night and morning of surgery	Placebo supplements, standard care
Kaibori et al[24], 2013	Patient tailored exercise program. Dietary advice	Dietary advice
McIsaac et al[25], 2022	Strength training. Aerobic exercise. Flexibility training	Received physical activity recommendations pamphlet
Mikkelsen et al[26], 2022	Exercise (60 minutes sessions twice a week). Protein supplement after each session. Individualized walking program. 2 nurse led counseling sessions	No interventions
Ngo-Huang et al[27], 2024	Aerobic and resistance training. Nutrition counseling	Recommended to stay active and given informational material

Table 3 Quality assessment of included studies

Ref.	Randomization technique	Power calculation	Blinding	Intention-to-treat	concealment	Inclusion criteria	Exclusion criteria
Ausania et al[20], 2019	Not reported	Yes	Single blind	Not reported	Not reported	Yes	Yes
Dunne et al[21], 2016	Random number block	Not reported	Single blind	Not reported	Not reported	Yes	Yes
Gade et al[22], 2016	Envelopes	Yes	Single blind	Yes	Yes	Yes	Yes
Griffiths et al[23], 2024	Computer generated	Not reported	Double blind	Not reported	Not reported	Yes	Yes
Kaibori et al[24], 2013	Not reported	Not reported	Not reported	Not reported	Not reported	Yes	Yes
McIsaac et al[25], 2022	Computer generated	Yes	Double blind	Yes	Yes	Yes	Yes
Mikkelsen et al[26], 2022	REDCap application	Yes	Single blind	Not reported	Not reported	Yes	Yes
Ngo-Huang et al[27], 2024	Pocock-Simon minimization method	Yes	No blinding	Not reported	Not reported	Yes	Yes