---
title: "Prehabilitation for Gastric Cancer Surgery: RCT Evidence from Unimodal to Multimodal Programs"
id: "pubmed-42560411"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42560411"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42560411/"
doi: "10.1007/s12029-026-01519-6"
published_at: "2026-08-06T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Prehabilitation for Gastric Cancer Surgery: RCT Evidence from Unimodal to Multimodal Programs
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42560411
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42560411/)
- **DOI:** [10.1007/s12029-026-01519-6](https://doi.org/10.1007%2Fs12029-026-01519-6)
- **Published At:** 2026-08-06T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This systematic review synthesized randomized controlled trial (RCT) evidence on **prehabilitation** before **gastric cancer** resection, aiming to optimize preoperative physical and nutritional status to improve perioperative resilience. - The review followed PRISMA methods and was registered on PROSPERO (CRD420251233981). Searches included MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL up to August 2025. - Fourteen RCTs met inclusion criteria: four **multimodal** programs and ten unimodal interventions (nine **nutritional**, one spirometry). Intervention durations ranged from 7 days to 15 weeks. - Reviewers extracted data and assessed risk of bias independently; heterogeneity prevented meta-analysis and narrative synthesis was used. - Across trials, authors reported 53 unique outcomes categorized into five domains: clinician/observer-reported outcomes, performance outcomes, patient-reported outcomes, biomarkers, and non-health outcomes. - Multimodal prehabilitation suggested potential benefits including fewer postoperative complications and improved functional capacity in the perioperative period. - Short-duration unimodal **nutritional** interventions showed mixed effects overall; however, **immune-nutrition** and targeted supplementation were associated with reduced infectious complications in malnourished patients in some trials. - The evidence base is limited by substantial heterogeneity in interventions, outcome selection and timing, and variable methodological quality; risk-of-bias assessments indicated seven trials with some concerns and seven at high risk. - The authors highlight the urgent need for a disease-specific core outcome set for gastric cancer prehabilitation and call for adequately powered, risk-stratified RCTs to support stronger evidence synthesis and implementation.
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Affiliations Expand ### Affiliations * 1 Department of Surgery, National University Hospital, Singapore, Singapore. * 2 Discipline of Physiotherapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland. * 3 Trinity St James's Cancer Institute, Dublin, Ireland. * 4 PanAsia Surgery, Singapore, Singapore. * 5 John Stearne Library, Trinity College, the University of Dublin, Dublin, Ireland. * 6 UCD Clinical Research Centre, School of Medicine, University College Dublin, Belfield, Dublin, Dublin 4, Ireland. linda.oneill1@ucd.ie. * PMID: **42560411** * DOI: [ 10.1007/s12029-026-01519-6 ](https://doi.org/10.1007/s12029-026-01519-6) Item in Clipboard Review # Unimodal to Multimodal Prehabilitation in Gastric Cancer Surgery: Systematic Review of Randomised Controlled Trials Maria Wobith et al. J Gastrointest Cancer. 2026. Show details Display options Display options Format Abstract PubMed PMID J Gastrointest Cancer Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Gastrointest+Cancer%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Gastrointest+Cancer%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42560411/) . 2026 Aug 6;57(1):178. doi: 10.1007/s12029-026-01519-6. ### Authors [Maria Wobith](https://pubmed.ncbi.nlm.nih.gov/?term=Wobith+M&cauthor_id=42560411)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42560411/#short-view-affiliation-1 "Department of Surgery, National University Hospital, Singapore, Singapore."), [Emer Guinan](https://pubmed.ncbi.nlm.nih.gov/?term=Guinan+E&cauthor_id=42560411)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42560411/#short-view-affiliation-2 "Discipline of Physiotherapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland.")[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42560411/#short-view-affiliation-3 "Trinity St James's Cancer Institute, Dublin, Ireland."), [Edward Cheong](https://pubmed.ncbi.nlm.nih.gov/?term=Cheong+E&cauthor_id=42560411)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42560411/#short-view-affiliation-4 "PanAsia Surgery, Singapore, Singapore."), [David Mockler](https://pubmed.ncbi.nlm.nih.gov/?term=Mockler+D&cauthor_id=42560411)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42560411/#short-view-affiliation-5 "John Stearne Library, Trinity College, the University of Dublin, Dublin, Ireland."), [Linda O'Neill](https://pubmed.ncbi.nlm.nih.gov/?term=O%27Neill+L&cauthor_id=42560411)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42560411/#short-view-affiliation-6 "UCD Clinical Research Centre, School of Medicine, University College Dublin, Belfield, Dublin, Dublin 4, Ireland. linda.oneill1@ucd.ie.") ### Affiliations * 1 Department of Surgery, National University Hospital, Singapore, Singapore. * 2 Discipline of Physiotherapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland. * 3 Trinity St James's Cancer Institute, Dublin, Ireland. * 4 PanAsia Surgery, Singapore, Singapore. * 5 John Stearne Library, Trinity College, the University of Dublin, Dublin, Ireland. * 6 UCD Clinical Research Centre, School of Medicine, University College Dublin, Belfield, Dublin, Dublin 4, Ireland. linda.oneill1@ucd.ie. * PMID: **42560411** * DOI: [ 10.1007/s12029-026-01519-6 ](https://doi.org/10.1007/s12029-026-01519-6) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Purpose:** Prehabilitation prior to gastric cancer resection aims to optimise pre-operative physical and nutritional status to improve perioperative resilience. However, the current evidence-base is fragmented. This review synthesized randomized controlled trial (RCT) evidence evaluating effectiveness of prehabilitation interventions prior to gastric cancer resection and characterized reported outcomes. **Methods:** A systematic review was conducted following PRISMA guidelines (PROSPERO registration -CRD420251233981). MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL were searched up to August 2025. Eligible studies were RCTs investigating unimodal or multimodal prehabilitation interventions (minimum duration 7 days) prior to gastric cancer resection. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Heterogeneity precluded meta-analysis and results were synthesized narratively. **Results:** Fourteen RCTs were included: four multimodal, and ten unimodal interventions (nutritional (n = 9), spirometry (n = 1)), duration range (7-days to 15-weeks). Fifty-three unique outcomes were reported across five domains: clinician/observer-reported outcomes, performance outcomes, patient-reported outcomes, biomarkers, and non-health outcomes. Multimodal prehabilitation programs suggest potential benefits; fewer postoperative complications, and improved functional capacity. Short-duration unimodal nutritional interventions demonstrated mixed effects, although immune-nutrition and targeted supplementation reduced infectious complications in malnourished patients. Findings were limited by risk-of-bias (some concerns (n = 7), high (n = 7)). **Conclusion:** Prehabilitation in gastric cancer surgery demonstrated a potential benefit, particularly when delivered as multimodal interventions. However, the evidence base is limited by substantial heterogeneity, variable methodological quality, and inconsistent outcome reporting. Development of a disease-specific core outcome set is urgently required, in addition to adequately powered, risk-stratified trials to advance evidence synthesis and implementation of gastric cancer prehabilitation. **Keywords:** Gastrectomy; Gastric cancer; Outcomes; Perioperative care; Prehabilitation. © 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Competing interests: The authors declare no competing interests. ## References 1. 1. Sung H, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2020;71(3):209–49. 2. 1. GlobalSurg Collaborative and NIHR Global Health Unit on Global Surgery. Impact of malnutrition on early outcomes after cancer surgery: an international, multicentre, prospective cohort study. Lancet Glob Health, 2023. 11(3): pp. e341–9. 3. 1. Terayama M, et al. Long-term impact of sarcopenia in older patients undergoing gastrectomy for gastric cancer: a systematic review and meta-analysis. Transl Gastroenterol Hepatol. 2023;8:35. - [DOI](https://doi.org/10.21037/tgh-23-34) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/38021358/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/10643178/) 4. 1. Kanda M. Preoperative predictors of postoperative complications after gastric cancer resection. Surg Today. 2020;50(1):3–11. - [DOI](https://doi.org/10.1007/s00595-019-01877-8) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/31535226/) 5. 1. Wang H, et al. Sarcopenia as a predictor of postoperative risk of complications, mortality and length of stay following gastrointestinal oncological surgery. Ann R Coll Surg Engl. 2021;103(9):630–7. - [DOI](https://doi.org/10.1308/rcsann.2021.0082) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/33739153/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/10335206/) Show all 49 references ## Publication types * Systematic Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Systematic+Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Systematic+Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42560411/) * Review Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Review%22%5Bpt%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Review) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42560411/) ## MeSH terms * Gastrectomy* Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Gastrectomy%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Gastrectomy) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42560411/) * Humans Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Humans%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Humans) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42560411/) * Postoperative Complications* / prevention & control Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Postoperative+Complications%2Fprevention+and+control%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Postoperative+Complications) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42560411/) * Preoperative Care* / methods Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Preoperative+Care%2Fmethods%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Preoperative+Care) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42560411/) * Preoperative Exercise* Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Preoperative+Exercise%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Preoperative+Exercise) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42560411/) * Randomized Controlled Trials as Topic Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Randomized+Controlled+Trials+as+Topic%22%5BMeSH%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Randomized+Controlled+Trials+as+Topic) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42560411/) * Stomach Neoplasms* / rehabilitation Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Stomach+Neoplasms%2Frehabilitation%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Stomach+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42560411/) * Stomach Neoplasms* / surgery Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Stomach+Neoplasms%2Fsurgery%22%5BMAJR%5D&sort=date&sort_order=desc) * [ Search in MeSH ](https://www.ncbi.nlm.nih.gov/mesh?term=Stomach+Neoplasms) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42560411/) [x] Cite Copy Download .nbib .nbib Format: AMA APA MLA NLM **Send To** * [Clipboard](https://pubmed.ncbi.nlm.nih.gov/42560411/) * [Email](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42560411%2F%23open-email-panel) * [Save](https://pubmed.ncbi.nlm.nih.gov/42560411/) * [My Bibliography](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42560411%2F%23open-bibliography-panel) * [Collections](https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F42560411%2F%23open-collections-panel) * [Citation Manager](https://pubmed.ncbi.nlm.nih.gov/42560411/) [x] NCBI Literature Resources [MeSH](https://www.ncbi.nlm.nih.gov/mesh/) [PMC](https://www.ncbi.nlm.nih.gov/pmc/) [Bookshelf](https://www.ncbi.nlm.nih.gov/books) [Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). 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