Prehabilitation as a component of preparation for gastric and gastro-esophageal junction cancer surgery: a review of literature

Introduction. Patients with localized and locally advanced gastric cancercommonly demonstrate high frequency of nutritional deficiency as well as impaired physical status while being in need of complex surgical interventions.This led to the development of “multimodal prehabilitation”concept including physical training, nutritional and psychological support. 

Aim. We aim to summarize recent literature regarding the impact of prehabilitation on the surgical treatment of patients with gastric and gastro-esophageal junction cancer.

Results. Eight studies comprising 347 patients were included. All studies had functional tests as the primary end-point. Studies used a 6-minute walk test or hand grip strength test to measure physical performance. Sixstudies showed an increase in functional capacity in the prehabilitation group,4 studies demonstrated significant improvement of health-related quality of life and 1 study revealed a significant decrease in the level of anxiety and depression (according to the HADS scale) after prehabilitation.All studies did not demonstrate the impact of prehabilitation on postoperative complications and mortality as well as nutrition status of gastric cancer patients.

Conclusions. Heterogeneity of prehabilitation programs as well as the absence of randomized trials preclude wide adoption of multimodal prehabilitation. Standardized prehabilitation programsare neededto further understandthe influence of prehabilitation on the clinical trajectory of patients with gastric and GEJ cancer. Also, the preliminary selection of high-risk patients is required to evaluate the clinical importance of prehabilitation. 

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