Prehabilitation to reduce postoperative complications in frail and elderly patients with gastrointestinal cancer: a systematic review and meta-analysis

TL;DR

Prehabilitation before surgery reduces complications in elderly and frail patients with gastrointestinal cancer, according to a review of clinical trials.

Contribution

This study provides the first meta-analysis showing prehabilitation's effectiveness in reducing postoperative complications in frail and elderly gastrointestinal cancer patients.

Findings

Prehabilitation reduced postoperative complications with a risk ratio of 0.67.

Subgroup analyses suggested greater benefit for frail patients and shorter interventions.

Low heterogeneity among studies indicates consistent results across trials.

Abstract

Elderly and frail patients with gastrointestinal cancer are at significantly increased risk of postoperative complications. The effectiveness of preoperative prehabilitation in this high-risk population requires synthesis of the existing evidence.

To evaluate the impact of preoperative prehabilitation on the incidence of postoperative complications in elderly (≥60 years) and frail patients with gastrointestinal cancer through a systematic review and meta-analysis.

We systematically searched PubMed, Embase, the Cochrane Library, and Web of Science from January 2020 to November 2025. Randomized controlled trials comparing prehabilitation with usual care were included. The primary outcome was the incidence of overall postoperative complications. Risk ratios were pooled using a random-effects model. Risk of bias was assessed using the ROB 2.0 tool. Subgroup analyses were conducted based on intervention duration (≥4 weeks vs. <4 weeks), surgery type (colorectal vs. other), and frailty status.

Nine randomized controlled trials involving 1027 patients were included. The meta-analysis showed that prehabilitation significantly reduced the risk of postoperative complications (risk ratio [RR] = 0.67, 95% confidence interval [CI]: 0.46 to 0.99, p = 0.04), with low heterogeneity among studies (I² = 24%). Subgroup analyses indicated a greater trend towards risk reduction in frail patients (RR = 0.53, 95% CI: 0.24 to 1.16), as well as in interventions lasting <4 weeks (RR = 0.54, 95% CI: 0.30-0.99) and in patients undergoing non-colorectal surgery (RR = 0.54, 95% CI: 0.30-0.99). However, differences between all subgroups were not statistically significant (p for interaction > 0.05).

Current evidence suggests that preoperative prehabilitation reduces postoperative complication risk in elderly patients undergoing gastrointestinal cancer surgery. While the effect is clear in the overall population, the trend suggesting potentially greater benefit in specifically frail patients requires confirmation in future larger, specifically designed trials. Integrating prehabilitation into the clinical pathway for this high-risk population is warranted.

https://www.crd.york.ac.uk/prospero/, identifier CRD420251275161.

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