The impact of multimodal prehabilitation on surgical outcomes in gynaecological cancer surgery

Abstract

OBJECTIVE: Surgical treatment for gynaecological malignancies is associated with significant postoperative morbidity. This study evaluated the impact of a structured, multimodal prehabilitation programme on postoperative complications, length of hospital stay, and readmissions in women undergoing surgery for a gynaecological cancer. METHODS: This prospective cohort study included women undergoing gynaecological cancer surgery (May 2021-July 2025), comprising participants in the F4S PREHAB trial and those treated after implementation of prehabilitation as standard care. The intervention group engaged in a multimodal programme, comprised supervised exercise training, nutritional optimisation (protein and vitamin D supplementation), psychological support, and counselling for smoking and alcohol cessation. The control group received standard recommendations based on national guidelines. The primary outcome was postoperative complications, with secondary outcomes including length of hospital stay, ICU-admission, ER-visits and readmissions. RESULTS: A total of 426 women were included, of whom 180 participated in the prehabilitation programme and 246 were included in the control group. Overall, 32% of women experienced one or more postoperative complications. Participation in prehabilitation was associated with a significant lower incidence of complications (27% vs 37%; p = 0.016), fewer wound complications (p < 0.001), fewer surgical complications (p = 0.008) and fewer complications per individual (p = 0.011). In addition, wound complications occurred less frequently in women undergoing prehabilitation prior to open surgery (11% vs 25%; p = 0.001). No significant differences were observed in secondary outcomes. CONCLUSION: This study showed that a multimodal prehabilitation programme was associated with a significant reduction in overall postoperative morbidity. No differences were observed in severe complications, length of stay or readmissions, warranting further research.