The Effect of Multimodal Prehabilitation on Functional Capacity and Postoperative Complications in Gastrointestinal Cancer Surgery

Objective: This study evaluated multimodal perioperative prehabilitation – combining exercise, nutrition, and psychological interventions – on functional capacity (6MWT distance, reflecting cardiopulmonary fitness) and clinical outcomes (postoperative complications, hospital stay, mortality, readmission rates) in gastrointestinal cancer surgery. Methods: We conducted a systematic review and meta-analysis of 12 prospective trials ( n =1,229) identified via the PubMed, Web of Science, Cochrane Library and Embase databases from their inception to 20 March 2025. Heterogeneity was evaluated with I ² and Q tests; random- or fixed-effects models were applied. Results: Multimodal prehabilitation significantly improved the 6MWT preoperatively (mean difference [MD] 30.1 m; 95% CI: 14.8–45.4) and at 4 weeks (MD 21.5 m; 95% CI: 14.1–28.9) and 8 weeks postoperatively (MD 38.7 m; 95% CI: 1.9–75.4). It was associated with a 0.86 days (95% CI: −1.43–−0.30) shorter hospital stay and lowered overall (risk ratio [RR] 0.67; 95% CI: 0.57–0.79) and severe complications (RR 0.77; 95% CI: 0.61–0.97), with no effect on operative time, mortality or readmission. Conclusion: This study shows patients receiving multimodal prehabilitation achieve better functional recovery (6MWT) and fewer complications, supporting its integration into perioperative care.