• Augustinas Bausys, Martynas Luksta, Giedre Anglickiene, Vyte V Maneikiene, Marius Kryzauskas, Andrius Rybakovas, Audrius Dulskas, Justas Kuliavas, Eugenijus Stratilatovas, Lina Macijauskiene, Toma Simbelyte, Jelena Celutkiene, Ieva E Jamontaite, Alma Cirtautas, Svetlana Lenickiene, Dalia Petrauskiene, Evelina Cikanaviciute, Edita Gaveliene, Gertruda Klimaviciute, Kornelija Rauduvyte, Rimantas Bausys, and Kestutis Strupas.
• Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.
• Br J Surg. 2023 Nov 9; 110 (12): 180018071800-1807.

BackgroundRecent studies have demonstrated that prehabilitation improves patients' physical fitness but its impact on postoperative morbidity remains unclear. This study aimed to assess the effect of personalized, multimodal, semisupervised, home-based prehabilitation on postoperative complications after surgery for gastric cancer.MethodsThis RCT was conducted at two centres in Lithuania. Patients (aged at least18 years) with gastric cancer scheduled to undergo elective primary surgery or surgery after neoadjuvant chemotherapy for gastric cancer were randomized (1 : 1) to prehabilitation or standard care. Prehabilitation included exercise interventions focused on endurance, respiratory muscle strength, stretching, and resistance training as well as nutritional and psychological support. The primary outcome was the proportion of patients with postoperative complications within 90 days after surgery. Secondary outcomes included 90-day mortality rate, physical condition, fitness level, nutritional status, quality of life, anxiety and depression level, and proportion of patients completing neoadjuvant chemotherapy.ResultsBetween February 2020 and September 2022, 128 participants were randomized to prehabilitation (64) or standard care (64), and 122 (prehabilitation 61, control 61) were analysed. The prehabilitation group had increased physical capacity before the operation compared with baseline (mean 6-min walk test change +31 (95 per cent c.i. 14 to 48) m; P = 0.001). The prehabilitation group had a decreased rate of non-compliance with neoadjuvant treatment (risk ratio (RR) 0.20, 95 per cent c.i. 0.20 to 0.56), a 60 per cent reduction in the number of patients with postoperative complications at 90 days after surgery (RR 0.40, 0.24 to 0.66), and improved quality of life compared with the control group.ConclusionPrehabilitation reduced morbidity in patients who underwent gastrectomy for gastric cancer.Registration NumberNCT04223401 (http://www.clinicaltrials.gov).© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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