Prehabilitation Improves Recovery in Patients Undergoing Endoscopic Submucosal Dissection

Overview

A randomized controlled trial evaluated a 4-week multimodal prehabilitation program versus standard care in patients undergoing endoscopic submucosal dissection (ESD). The study demonstrated that prehabilitation enhanced physical function, reduced postoperative complications, and improved quality of life, suggesting benefits even in minimally invasive procedures.

Background

Prehabilitation is a multimodal preoperative conditioning approach aimed at improving patients' fitness and resilience before surgery to enhance postoperative outcomes. While evidence supports its efficacy in major elective surgeries by reducing complications and accelerating recovery, its role in minimally invasive procedures like ESD remains unclear. ESD is increasingly used for early gastrointestinal neoplasms but patients often remain vulnerable to sedation-related and postoperative risks. This study addresses the knowledge gap by investigating whether prehabilitation benefits extend to ESD patients.

Data Highlights

The study was a single-center, assessor-blinded randomized controlled trial with adult patients scheduled for elective ESD. Participants were randomized 1:1 to either a 4-week prehabilitation program or usual care. The prehabilitation program included individualized exercise, nutritional support, and psychological preparation delivered by a multidisciplinary team. Outcomes assessed included physical functional status, postoperative complications, length of hospital stay, and health-related quality of life.

Key Findings

• Prehabilitation patients showed improved physical functional status prior to surgery compared to controls.
• The incidence of postoperative complications was reduced in the prehabilitation group relative to usual care.
• Length of hospital stay was shorter among patients who underwent prehabilitation.
• Health-related quality of life scores were higher postoperatively in the prehabilitation arm.
• Adherence to the prehabilitation program was feasible and well tolerated without significant adverse events.

Clinical Implications

Implementing a structured prehabilitation program before ESD can enhance patient resilience and recovery, even in minimally invasive procedures traditionally considered low risk. Clinicians should consider multidisciplinary preoperative conditioning to optimize outcomes, particularly in older or frail patients undergoing ESD. This approach may reduce complications and shorten hospitalization, potentially improving cost-effectiveness of care.

Conclusion

This randomized trial provides evidence that prehabilitation improves postoperative recovery outcomes in patients undergoing ESD. Extending prehabilitation principles to endoscopic procedures represents a promising strategy to enhance surgical care.

References

1. Systematic Reviews and Meta-Analyses on Prehabilitation Benefits
2. Network Meta-Analysis on Combined Prehabilitation Outcomes
3. Multicenter Trial in Colorectal Surgery Demonstrating Prehabilitation Efficacy
4. Systematic Review of Economic Evaluations of Prehabilitation