- Design
- Systematic review and meta-analysis, 2 RCTs and 10 comparative observational studies
- Population
- 1,841 adults having elective pancreatic resection
- Primary outcome
- Overall postoperative complications
- Effect
- RR 0.85 (95% CI 0.76–0.95) all studies; RR 0.53 (0.36–0.77) RCTs only
A systematic review and meta-analysis pooled 12 comparative studies of multimodal prehabilitation before elective pancreatic resection, totalling 1,841 patients. Only two were randomised trials, together contributing 128 patients.
Across all studies, prehabilitation was associated with fewer overall complications (RR 0.85, 95% CI 0.76–0.95) and less delayed gastric emptying (RR 0.77, 0.63–0.94). The trial-only analysis showed larger effects (RR 0.53 and 0.34) but from very few patients. There was no significant effect on major complications, pancreatic fistula, length of stay, readmission or mortality.
The authors call the findings exploratory, and that is the right reading. Prehabilitation is low-risk and fits within the time most patients wait for pancreatic surgery, but it should not delay a cancer operation, and the trials needed to show it changes serious outcomes have not been done.
- Consider exercise, nutrition and psychological preparation in the weeks before elective pancreatic resection.
- Do not delay a cancer resection to complete a prehabilitation programme.
- Screen for malnutrition and sarcopenia at the first surgical visit, when there is still time to act.
- Tell patients the benefit is mainly in minor complications and delayed gastric emptying, not survival.
Why it matters
Programmes are spreading ahead of the evidence, and this shows how thin that evidence still is.
Don't overread it
Ten of twelve studies were observational — no effect on fistula, major complications or mortality was shown.
The statistics, in plain English
A risk ratio of 0.85 is a 15% relative reduction in overall complications. The larger effects in the trial-only analysis come from 128 patients, so their confidence intervals are wide and the estimates unstable. Mostly observational data means fitter, more motivated patients may have chosen prehabilitation.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for general surgery, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free