Impact of multimodal prehabilitation on surgical recovery after elective gastrectomy for gastric cancer: a systematic review and meta-analysis

Multimodal prehabilitation has been increasingly used to enhance perioperative resilience in patients undergoing elective surgery for gastric cancer (GC). However, its effects on postoperative morbidity and recovery outcomes remain inconsistent. This systematic review and meta-analysis aimed to evaluate the impact of multimodal prehabilitation on postoperative outcomes after elective gastrectomy for GC. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to February 28, 2026. Randomized controlled trials comparing multimodal prehabilitation with standard care or ERAS-based care in adults scheduled for elective gastrectomy for GC were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. The protocol was registered in PROSPERO (CRD420261422881). Five studies involving 975 patients were included, comprising 483 patients in the prehabilitation group and 492 in the control group. Baseline characteristics were generally comparable between groups. Compared with standard care, multimodal prehabilitation significantly reduced overall postoperative complications (OR = 0.42, 95% CI 0.31–0.57; P < 0.001; I² = 2%) and pulmonary complications (OR = 0.37, 95% CI 0.22–0.63; P < 0.001; I² = 0%). It also significantly shortened postoperative hospital stay (MD = − 1.55 days, 95% CI − 1.89 to − 1.22; P < 0.001; I² = 0%). No significant differences were observed in severe postoperative complications (OR = 0.74, 95% CI 0.41–1.34; P > 0.05; I² = 0%) or 30-day readmission (OR = 0.71, 95% CI 0.35–1.42; P > 0.05; I² = 0%). Sensitivity analyses, including exclusion of the study without a clearly described exercise or respiratory training component and leave-one-out analyses, showed broadly consistent results. Multimodal prehabilitation before elective gastrectomy for GC appears to improve surgical recovery by reducing overall and pulmonary complications and shortening postoperative hospital stay. Larger randomized trials are needed to confirm these benefits.