Unimodal to Multimodal Prehabilitation in Gastric Cancer Surgery: Systematic Review of Randomised Controlled Trials.

Authors

Maria Wobith, Emer Guinan, Edward Cheong, David Mockler, Linda O'Neill

Published in

Journal of gastrointestinal cancer. Volume 57. Issue 1. Aug 06, 2026. Epub Aug 06, 2026.

Abstract

Prehabilitation prior to gastric cancer resection aims to optimise pre-operative physical and nutritional status to improve perioperative resilience. However, the current evidence-base is fragmented. This review synthesized randomized controlled trial (RCT) evidence evaluating effectiveness of prehabilitation interventions prior to gastric cancer resection and characterized reported outcomes.
A systematic review was conducted following PRISMA guidelines (PROSPERO registration -CRD420251233981). MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL were searched up to August 2025. Eligible studies were RCTs investigating unimodal or multimodal prehabilitation interventions (minimum duration 7 days) prior to gastric cancer resection. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Heterogeneity precluded meta-analysis and results were synthesized narratively.
Fourteen RCTs were included: four multimodal, and ten unimodal interventions (nutritional (n = 9), spirometry (n = 1)), duration range (7-days to 15-weeks). Fifty-three unique outcomes were reported across five domains: clinician/observer-reported outcomes, performance outcomes, patient-reported outcomes, biomarkers, and non-health outcomes. Multimodal prehabilitation programs suggest potential benefits; fewer postoperative complications, and improved functional capacity. Short-duration unimodal nutritional interventions demonstrated mixed effects, although immune-nutrition and targeted supplementation reduced infectious complications in malnourished patients. Findings were limited by risk-of-bias (some concerns (n = 7), high (n = 7)).
Prehabilitation in gastric cancer surgery demonstrated a potential benefit, particularly when delivered as multimodal interventions. However, the evidence base is limited by substantial heterogeneity, variable methodological quality, and inconsistent outcome reporting. Development of a disease-specific core outcome set is urgently required, in addition to adequately powered, risk-stratified trials to advance evidence synthesis and implementation of gastric cancer prehabilitation.

PMID:
42560411
Bibliographic data and abstract were imported from PubMed on 06 Aug 2026.

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