Prehabilitation options for major oncological surgery: A systematic review and meta-analysis of randomised controlled trials

BACKGROUND – Prehabilitation after major surgery may enhance physiological reserve and reduce postoperative morbidity. However, its efficacy after oncological surgery remains uncertain. OBJECTIVE – To identify and evaluate the effects of prehabilitation on postoperative complications in adults undergoing elective surgery for malignancy, compared with standard peri-operative care. DESIGN – Systematic reviews and meta-analysis of randomised controlled trials (RCTs). Cochrane Risk of Bias Tool and Grading of Recommendations, Assessment, Development, and Evaluation were used and this meta-analysis (PROSPERO-CRD420251116873) was written according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA). DATA SOURCES – Central, Medline, Embase and Scopus were systematically searched from inception to 9 September 2025. ELIGIBILITY CRITERIA – Eligible studies met the following criteria: (P) adults undergoing elective major oncological surgery; (I) nature of prehabilitation (physical exercise, nutritional support, psychological preparation); (C) standard peri-operative management; (O) postoperative complications within 30 days or before discharge, defined by the Clavien–Dindo classification and (S) RCTs only. RESULTS – Eighty–one RCTs (8145 patients) were included in this network meta–analysis. Compared with usual care, isolated nutrition reduced the number of patients with complications with an odds ratio (OR) of 0.39 and a 95% confidence interval (CI) of 0.23 to 0.68. The combination of nutrition, exercise, and psychological prehabilitation produced a larger reduction (OR 0.19, 95% CI 0.08 to 0.46) (low–certainty evidence). Isolated nutrition also decreased the global number of complications (OR 0.61, 95% CI 0.41 to 0.90) (low–certainty evidence). Nutrition or exercise interventions were most likely to reduce length of stay, with mean differences of −1.59 days (95% CI −2.38 to −0.80) and −1.20 days (95% CI −1.84 to −0.58), respectively (very low–certainty evidence). Among patients undergoing abdominal cancer surgery, isolated nutrition (OR 0.36, 95% CI 0.19 to 0.69) and combined nutrition, exercise, and psychological prehabilitation (OR 0.18, 95% CI 0.07–0.47) showed greater benefit. No significant effects were observed for hospital mortality or health?related quality of life. CONCLUSION – Prehabilitation, particularly nutritional and multimodal programs integrating exercise, diet and psychological support, reduces postoperative complications in oncology patients, especially after abdominal surgery, despite some uncertainty in our estimates.