Cancer surgery is often discussed in terms of tumor size, stage, margins, and survival. Yet an equally important factor frequently gets overlooked: the physical condition patients bring into the operating room. Prehabilitation—structured programs that improve strength, aerobic capacity, and nutritional status before surgery—is rapidly emerging as a clinically important strategy to reduce complications, improve recovery, and support long-term outcomes.
Recent evidence across different cancer types reinforces this. In gynecologic oncology, a large stepped-wedge trial evaluated a multimodal prehabilitation program including supervised exercise, daily aerobic activity, individualized nutrition therapy, and psychological support before surgery. The results were striking. Women significantly improved their aerobic fitness (VO₂ peak increased by 8%), leg strength improved by 20%, functional performance improved on validated mobility tests, and importantly, the proportion of women at moderate or high nutritional risk dropped from 29% to 19%. Many patients moved from a “higher-risk” physiological category to a “lower-risk” category before they ever reached the operating table. These gains are clinically meaningful, because better physiological reserve is strongly associated with fewer postoperative complications, faster recovery, and shorter hospital stays.
Compelling randomized clinical trial evidence supports these benefits beyond gynecologic cancer. In the PREHEP randomized trial, patients with sarcopenia undergoing major liver resection completed a six-week structured prehabilitation program combining supervised strength and endurance exercise with targeted nutritional supplementation. Compared with standard care, postoperative morbidity dropped dramatically—from 50% to just 13.3%. All major complications occurred only in the control group. The number needed to treat was astonishingly low: for every three patients who received prehabilitation, one major complication was prevented. This trial did more than prove feasibility; it demonstrated that what has long been considered an unmodifiable “risk factor”—sarcopenia—is, in fact, modifiable through intentional preoperative intervention.
Together, these studies tell a powerful story. Prehabilitation is not “extra” care. It is proactive medicine. It reframes the weeks before surgery—not as passive waiting time, but as a therapeutic window to build resilience. Physiologically, exercise and nutrition improve muscle mass, metabolic stability, inflammatory control, and cardiovascular reserve. Psychologically, structured programs reduce anxiety and enhance confidence. From a systems standpoint, reducing complications means fewer ICU admissions, lower costs, and better quality of life.
Clinically, prehabilitation is most valuable when it is multimodal, supervised, when possible, nutritively supported, and started as early as feasible. High-risk patients—such as those with frailty, sarcopenia, or undergoing major surgery—may benefit the most. But these data also suggest benefit for broader oncology populations.
The message for oncology teams, surgeons, and patients is clear: preparing the person is as important as preparing the operative plan. Prehabilitation is not just about getting through surgery—it is about positioning patients to do better afterward. As cancer care evolves, integrating structured prehabilitation into routine practice may become one of the most important shifts in modern surgical oncology.
References:
“The effect of a multimodal prehabilitation programme on preoperative physical fitness and nutritional status of women with gynaecological cancer” by J. Dhan, J.M.A. Pijnenbor, C.J.H.M. van Laarhoven, et al. Gynecologic Oncology 203 (2025) 1–7
“Prehabilitation With Exercise and Nutrition to Reduce Morbidity of Major Hepatectomy in Patients With Sarcopenia- The PREHEP Randomized Clinical Trial” by Giammauro Berardi, MD, PhD; Alessandro Cucchetti, MD, PhD; Marco Colasanti, MD, PhD; Marco Angrisani, MD; et al. JAMA Surg. 2025;160(10):1068-1075. doi:10.1001/jamasurg.2025.3102
