Effect of prehabilitation in patients undergoing gastric or oesophageal cancer resections: A systematic review and meta-analysis

Table 1 Characteristics of included studies

Ref.	Country	Operation	Number of patients	Age	Female:male	Duration of follow up	Trial running time
Aiko et al[18], 2012	Japan	Open oesophagectomy					2007- 2012
Prehabilitation			14	65 ± 2	1:13	1 week
No prehabilitation			12	61 ± 3	2:10
Allen et al[17], 2022	United Kingdom	Open oesophagectomy and gastrectomy					2016-2018
Prehabilitation			26	65 ± 6	4:22	3 years
No prehabilitation			28	62 ± 9	4:24
Barberan-Garciaet al[19], 2018	Spain	Oesophagectomy and gastrectomy (type not reported)				Until discharge, mean LOS: 8 ± 8, 13 ± 20	2013–2016
Prehabilitation			73	71 ± 11	19:43
No prehabilitation			71	71 ± 10	12:51
Bausys et al[20], 2023	Lithuania	Laparoscopic and open gastrectomy					2020-2022
Prehabilitation			61	61 ± 11	26:35	90 days
No prehabilitation			61	64 ± 10	19:42
Chen et al[21], 2024	China	Laparoscopic and open gastrectomy					2019-2023
Prehabilitation			57	73 (70.5-77)	24:33	30 days
No prehabilitation			58	74 (68-78)	30:28
Guinan et al[22], 2018	Ireland, Netherlands	Open oesophagectomy					2014-2016
Prehabilitation			28	63.07 ± 8.8	8:20	9 days
No prehabilitation			32	65.06 ± 67.78	10:22
He et al[23],2022	China	Gastrectomy (type not reported)					2020–2021
Prehabilitation			31	63.2 ± 12	7:24	1 month
No prehabilitation			35	60.5 ± 9.4	12:23
Liu et al[24],2020	China	Open and thorascopic oesophagectomy					January–June 2018
Prehabilitation			26	62.04 ± 5.12	5:21	1 month
No prehabilitation			24	64.58 ± 5.87	10:14
Loughney et al[25], 2024	Ireland	Laparoscopic, thorascopic, open, and robotic oesophagectomy and gastrectomy					2019-2020
Prehabilitation			36	62.8 ± 9.2	9:27	6 weeks
No prehabilitation			35	61.5 ± 8.8	10:25
Minnella et al[7], 2018	Canada	Open and minimally invasive oesophagectomy and gastrectomy					2013-2017
Prehabilitation			26	67.3 ± 7.4	8:18	8 weeks
No prehabilitation			25	68 ± 11.6	5:20
Swaminathan et al[26], 2020	India	Open gastrectomy					2017-2019
Prehabilitation			29	56.03 ± 14.95	11:18	2 weeks
No prehabilitation			29	56.82 ± 11.27	9:20
Valkenet et al[27], 2018	Netherlands	Open, laparoscopic, and robotic oesophagectomy					2013-2016
Prehabilitation			120	63. ± 7.5	31:89	15 days
No prehabilitation			121	62.7 ± 8.9	24:97
Wang et al[28], 2015	China	Gastrectomy (type not reported)					2010-2012
Prehabilitation			100	38-72	70:130	10 days
No prehabilitation			100
Yamana et al[29], 2015	Japan	Open and thorascopic oesophagectomy				Until discharge	2011-2014
Prehabilitation			30	68.33 ± 7.64	6:24
No prehabilitation			30	65.9 ± 9.5	7:23
Zhao et al[30], 2018	China	Oesophagogastric cancer resections				Until discharge, mean LOS: 7 ± 1, 8 ± 2	2012-2016
Prehabilitation			33	62 (26-74)	9:57
No prehabilitation			33
Zheng et al[31], 2024	China	Open and laparoscopic gastrectomy				Until discharge, mean LOS: 8.69 ± 1.92, 9.57 ± 2.16	Not reported
Prehabilitation			61	66.07 ± 8.97	51:9
No prehabilitation			60	63.72 ± 8.84	45:16

LOS: Length of stay.

Table 2 Treatment protocol adopted in included studies

Ref.	Intervention	Control
Aiko et al[18], 2012	Immune enhanced diets 5 days prior to surgery. Enteral feeding and parenteral mixture (UNICALIQ l) following surgery	Standard diets before surgery. Enteral feeding and parenteral mixture (UNICALIQ l) following surgery
Allen et al[17]	Supervised and home-based exercise program. Six sessions of medical coaching	Standardoesophagogastric care pathways. Encouraged to remain active, given dietary recommendations and psychological support
Barberan-Garciaet al[19], 2018	Personalised daily activity and exercise programs. Motivational interviewing	Standard care. Encouraged to make healthy lifestyle choices
Bausys et al[20], 2023	Personalised home-based prehabilitation program consisting of exercise, nutritional, and psychological support	Did not receive advice on prehabilitation related interventions, some were recommended supplementation prior to surgery
Chen et al[21], 2024	3-week individualised prehabilitation program consisting of exercise, respiratory training, nutritional, and psychological support	Did not receive any prehabilitation advice. ERAS recommendation
Guinan et al[22], 2018	Inspiratory muscle training program	Standard pathway
He et al[23],2022	Oral nutritional supplement for seven days	Standard dietary advice
Liu et al[24],2020	Oral nutrition supplement for all patients	ERAS, oral nutrition supplement if needed
Loughney et al[25], 2024	Standardised nutritional pathway. Exercise prehabilitation	Standardised nutritional pathway
Minnella et al[7], 2018	Exercise and nutrition programs	ERAS. Standard care
Swaminathan et al[26], 2020	Preoperative volume-oriented spirometry. Oral maltodextrin drink the night before and day of surgery. Oral midazolam on day of surgery. ERAS	Standard care
Valkenet et al[27], 2018	Inspiratory muscle training	Standard care
Wang et al[28], 2015	Daily nutritional protein-based supplement 1 week prior to surgery	Standard preoperative care
Yamana et al[29], 2015	Preoperative respiratory exercise training program	No interventions
Zhao et al[30], 2018	Oral nutrition supplement 7 days before surgery	Routine preoperative diet
Zheng et al[31], 2024	Preoperative pulmonary related training program	No interventions

ERAS: Enhanced recovery after surgery.

Table 3 Quality assessment of included studies

Ref.	Randomisation	Power calculation	Blinding	Concealment	ITT	Inclusion criteria	Exclusion criteria
Aiko et al[18], 2012	Envelope method	Not reported	Not reported	Not reported	Not reported	Reported	Reported
Allen et al[17]	Computer generated variable block size	Reported	Not reported	Reported	Reported	Reported	Reported
Barberan-Garciaet al[19], 2018	Computer generated random numbers	Not reported	Double	Not reported	Reported	Reported	Reported
Bausys et al[20], 2023	Computer generated	Reported	Not reported	Reported	Reported	Reported	Reported
Chen et al[21], 2024	Computer generated	Reported	Single	Reported	Reported	Reported	Reported
Guinan et al[22], 2018	Web based	Not reported	Single	Not reported	Not reported	Reported	Reported
He et al[23],2022	Random number tables	Reported	Single	Not reported	Not reported	Reported	Not reported
Liu et al[24],2020	Computer random number generation	Reported	Single	Not reported	No ITT	Reported	Reported
Loughney et al[25], 2024	Computer generated	Reported	Noblinding	Not reported	Reported	Reported	Not reported
Minnella et al[7], 2018	Computer generated	Reported	Single	Reported	Not reported	Reported	Reported
Swaminathan et al[26], 2020	Block randomisation	Reported	Not reported	Reported	Modified ITT	Reported	Reported
Valkenet et al[27], 2018	Web based	Reported	Single	Reported	Modified ITT	Reported	Reported
Wang et al[28], 2015	Computer generated	Not reported	Not reported	Reported	Not reported	Not reported	Not reported
Yamana et al[29], 2015	Not reported	Reported	Not reported	Reported	Not reported	Not reported	Not reported
Zhao et al[30], 2018	Table of random numbers	Not reported	Not reported	Not reported	Not reported	Reported	Reported
Zheng et al[31], 2024	Computer based random number table	Reported	Double	Reported	Not reported	Reported	Reported

ITT: Intention to treat.