Prehabilitation intervention is receiving increasing attention to improve the quality of recovery of a patient after surgery. In a new study, the researchers would focus on interventions for patients with gastrointestinal (GI) cancer.

The MEDLINE, PubMed, Embase, CINAHL, Cochrane, and Google Scholar databases were searched for publications that evaluated interventions related to preoperative optimization of patients with GI cancer. The possible interventions included exercise, nutritional support, hematinic optimization, and smoking cessation.

Outcomes of interest from the review of the selected articles included fitness at the end of the prehabilitation before surgery, postoperative morbidity and mortality, length of hospital stay, markers of functional fitness such as cardiopulmonary exercise, quality-of-life measures, transfusions, and levels of compliance with the prehabilitation interventions themselves.

Two trials (a total of 164 participants undergoing elective colorectal cancer surgery) investigated the impact of a month-long program of physical exercise (combination of aerobic and resistance training), nutritional assessment and whey protein supplementation, as well as anxiety-reduction techniques, including breathing exercises.

The four trials of preoperative iron replacement only had a variety of different interventions (two were oral iron supplements and two were intravenous iron infusions), and two studies included nonanemic patients. Because of the heterogeneity of interventions, results of these trials need to be interpreted with caution.

Similar heterogeneity was found in the nutritional optimization protocols (five trials) that included whey protein supplementation or supplemental liquid diet of 750-1000 mL daily of Impact®, or 400 mL daily of Nutridrink® Protein over a preoperative period ranging from 3 to 14 days. Preoperative smoking cessation for at least 2 weeks reduced the incidence of postoperative complications in patients awaiting esophagogastric surgery in one study.

Another study suggested that the duration of smoking cessation was more meaningful than the total amount of smoking in the past, with the incidence of severe morbidity in patients who abstained from smoking for >91 days is equivalent to non-smokers.

Although some of the small studies are supportive of prehabilitation interventions, there are not enough data to make a conclusion about the integration of prehabilitation in GI cancer surgery as a bundle of care. It may be difficult for a patient to fully immerse in a prehabilitation program as the patient may be dealing with the emotional and practical side effects of a new diagnosis requiring surgery.

More recently, prehabilitation programs have added dietician assessment of nutritional status followed by protein supplementation if appropriate and psychological support via training the patient with relaxation and breathing exercises as anxiety reduction measures.

The value of both of these elements of prehabilitation programs remains unknown because available clinical studies are heterogeneous in inclusion criteria, precise intervention, and endpoints. Prehabilitation could improve outcomes in GI cancer surgery. But, prospective randomized trials with controls are required that examine standardized structured interventions, outcome measures of functional capacity, and related clinical endpoints important to patients.