Multimodal prehabilitation enhances perioperative outcomes in gastric cancer patients: a single-center randomized controlled trial

TL;DR

A one-week prehabilitation program combining exercise, nutrition, and mental health support improves recovery and reduces complications in gastric cancer patients undergoing surgery.

Contribution

This study provides empirical evidence that a short, multimodal prehabilitation program is effective for gastric cancer patients requiring timely surgery.

Findings

The prehabilitation group had a significantly lower 30-day complication rate (9.1% vs. 26.2%) and fewer pulmonary infections.

Prehabilitation led to faster recovery metrics, including earlier ambulation, oral intake, and hospital discharge.

Patients in the prehabilitation group showed better preoperative physical and nutritional status and improved psychological well-being.

Abstract

Multimodal prehabilitation, integrating exercise, nutrition, and psychological support, has shown value in perioperative care for gastrointestinal cancers, but its efficacy—especially as a short-course intervention tailored to gastric cancer’s need for timely surgery—remains insufficiently validated.

Eligible patients undergoing radical gastrectomy received either a 1-week multimodal prehabilitation program plus standard perioperative care (prehabilitation group) or standard perioperative care alone (control group). Primary endpoint was the 30-day postoperative complication rate; secondary endpoints included functional capacity, patient-reported outcomes, recovery metrics, and hospital stay.

Recruitment was conducted from July 2022 to July 2024. A total of 150 patients were randomized, with 131 completing the trial (66 in the prehabilitation group, 65 in the control group). Baseline demographics (gender, age, education level) and clinical characteristics (comorbidities, TNM staging, surgical details) were comparable between groups (all p > 0.05). For the primary endpoint, the prehabilitation group had a significantly lower 30-day overall complication rate (9.1% vs. 26.2%, p = 0.010), with the largest reduction in pulmonary infections (6.1% vs. 21.5%, p < 0.05). For secondary endpoints, the prehabilitation group showed earlier time to first flatus (58.32 ± 26.82 vs. 89.55 ± 26.14 h, p < 0.001), shorter interval to oral intake (48.43 ± 31.98 vs. 105.85 ± 57.36 h, p < 0.001), reduced time to ambulation (25.14 ± 10.63 vs. 38.99 ± 21.01 h, p < 0.001), and shorter postoperative hospital stay (7.76 ± 1.57 vs. 9.77 ± 3.80 days, p < 0.001). They also had superior preoperative 6MWD (448.60 ± 103.65 vs. 362.43 ± 91.85 m, p < 0.001), higher preoperative caloric (25.21 ± 6.33 vs. 16.34 ± 4.44 Kcal/kg IBW, p < 0.001) and protein intake (1.24 ± 0.35 vs. 0.62 ± 0.25 g/kg IBW, p < 0.001), higher discharge QoR-40c scores (p < 0.05), and lower Hospital Anxiety and Depression Scale (anxiety: p = 0.026, depression: p < 0.001) and Fatigue Severity Scale scores (p = 0.003).

Multimodal prehabilitation (integrating exercise, nutrition, and psychological support) significantly improves perioperative outcomes in gastric cancer patients—including reducing postoperative complications, accelerating functional recovery, and enhancing psychological well-being.

ClinicalTrials.gov identifier ChiCTR2200062938.

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