The Effectiveness of Prehabilitation on Surgical Outcomes in Pancreatic Surgery: A Systematic Review and Meta-Analysis
In brief
Prehabilitation was linked to 15% fewer complications after pancreatic surgery
Across 12 studies involving 1,841 patients, prehabilitation was associated with 15% fewer overall complications and 23% fewer delayed gastric emptying events after pancreatic surgery. It did not significantly change hospital stay, major complications, deaths, readmissions or pancreatic fistula; most evidence was observational, and only two small randomized trials included 128 patients, so larger trials are needed to confirm the benefits.
- Journal
- World journal of surgery (Q1)
- Published
- 26 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Lyrics M Noba, Robyn J Stiger, Sanjay Pandanaboyana, Christopher J Gaffney, Lawrence D Hayes, Michael P W Grocott, et al.
- PMID
- 42935121
- DOI
- 10.1002/wjs.70639
Why clinicians should know about it
- Picked for Surgical Oncology (top studies of the week, 1 November 2026): Prehabilitation reduces complications in pancreatic surgery
- Picked for Surgery (top studies of the week, 1 November 2026): Prehabilitation evidence for complications after pancreatic resection
Abstract
BACKGROUND: Pancreatic surgery is associated with high rates of postoperative complications. Prehabilitation has emerged as a key preoperative strategy to optimize patients' physiological status prior to surgery. However, its specific role and efficacy in pancreatic surgery are not well established. This review aimed to examine the impact of multimodal prehabilitation interventions on key postoperative outcomes in patients undergoing elective pancreatic resection. METHODS: This systematic review and meta-analysis was reported in accordance with PRISMA guidelines. MEDLINE, Embase, Web of Science and the Cochrane Library were searched. RCTs and comparative observational studies evaluating prehabilitation programs in adult patients undergoing pancreatic surgery were included. Meta-analyses were performed for all studies combined, and separately for RCTs only and observational studies only. RESULTS: Twelve studies (two RCTs and 10 comparative observational studies) comprising 1841 patients were included. The RCT-only analysis was based on 128 patients. Prehabilitation was associated with significantly fewer overall postoperative complications (RR 0.85; 95% CI, 0.76-0.95; p = 0.005) and delayed gastric emptying (DGE) events (RR 0.77; 95% CI, 0.63-0.94; p = 0.01). In the RCT-only analysis, effects remained significant for overall complications (RR 0.53; 95% CI, 0.36-0.77; p = 0.001) and DGE (RR 0.34; 95% CI, 0.13-0.87; p = 0.02). However, there was no significant effect on length of stay (p = 0.10), major complications (p = 0.11), mortality (p = 0.26), readmission (p = 0.30) and postoperative pancreatic fistula (p = 0.83). CONCLUSION: This review suggests a potential morbidity benefit of prehabilitation for overall complications and delayed gastric emptying (DGE), but the evidence is derived predominantly from observational data, with only two small RCTs; these findings are exploratory and require confirmation in adequately powered randomized trials.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.