Impact of a Multimodal Prehabilitation Program on Perioperative Outcomes in Hepatopancreatobiliary Surgery: A Retrospective Cohort Study
by
,
Pipit Burasakarn
*
,
Nattaporn Maneepairoj
,
Vachiraluck Chalokool
,
Anuparp Thienhiran
,
Sermsak Hongjinda
and
Pusit Fuengfoo
Division of HPB Surgery, Department of Surgery, Phramongkutklao Hospital, Thung Phaya Thai, Ratchathewi, Bangkok 10400, Thailand
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2026, 33(4), 207; https://doi.org/10.3390/curroncol33040207
Submission received: 15 March 2026
/
Revised: 26 March 2026
/
Accepted: 4 April 2026
/
Published: 5 April 2026
(This article belongs to the Section Gastrointestinal Oncology)
Simple Summary
Major surgeries involving the liver and pancreas are physically demanding and often lead to long hospital stays. This study investigated whether a four-week “prehabilitation” program—consisting of supervised nutrition, exercise, and mental health support—could better prepare patients for these operations. We found that patients who participated in the program had better nutritional health on the day of surgery. Most importantly, patients undergoing complex pancreatic procedures recovered significantly faster, leaving the hospital up to five days earlier than those who did not participate. While the benefits were most noticeable in the most difficult surgeries, the results suggest that strengthening a patient’s physical reserve before an operation can lead to a quicker and more efficient recovery. These findings support making personalized “fitness for surgery” programs a standard part of hospital care.
Abstract
Background: Major hepatopancreatobiliary (HPB) surgeries cause significant physical stress. In this study, we evaluated how a 4-week multimodal prehabilitation program affects perioperative outcomes across different types of HPB procedures. Methods: We conducted a retrospective cohort study of 359 patients undergoing HPB surgery (162 historical controls and 197 in the prehabilitation group). To accurately assess the clinical benefits of various procedures, patients were stratified into specific surgical groups: major and minor hepatectomy, pancreatoduodenectomy (PD), and left pancreatectomy (LP). Results: The prehabilitation program significantly improved preoperative nutrition, demonstrated by increased serum albumin levels on the day of surgery (p < 0.001), and the clinical benefits were most pronounced in pancreatic surgeries. Patients undergoing PD in the prehabilitation group had a significantly shorter median hospital stay (8 versus 13 days, p < 0.001). LP patients also experienced shorter hospital stays (5 versus 9 days, p = 0.001) and reduced blood loss (p = 0.002). For minor hepatectomies, the intervention significantly lowered the need for blood transfusions (8.3% versus 18.9%, p = 0.033). The length of stay and complication rates for major hepatectomies remained comparable between groups. Importantly, major morbidities and 90-day mortality were low and similar across all cohorts. Conclusions: Multimodal prehabilitation successfully optimizes preoperative nutrition and accelerates hospital discharge, especially after highly stressful pancreatic surgeries. Because benefits vary by surgical magnitude, prehabilitation pathways should be tailored to prioritize high-risk patients facing complex operations.
