Open Access

ARTICLE

Prehabilitation in patients undergoing bladder cancer surgery – A systematic review and meta-analysis

Daniel Steffens^1,2,3, Cherry Koh^1,2,3,4, Nicholas Hirst^1,2, Ruby Cole^1,2, Michael J. Solomon^1,2,3,4, Lisa Nguyen-Lal⁵

1 Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, Australia
2 Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
3 Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, Australia
4 Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, Australia
5 Chris O’Brien Lifehouse, Camperdown, New South Wales, Sydney, Australia
Address correspondence to Prof Daniel Steffens, Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), PO Box M157 Missenden Road NSW 2050 Australia

Canadian Journal of Urology 2024, 31(5), 12004-12012.

Abstract

Introduction: The evidence on the effectiveness of prehabilitation in patients undergoing bladder cancer surgery remains lacking. Thus, the aim of this study is to determine the effectiveness of prehabilitation on reducing postoperative morbidity and length of hospital stay in patients undergoing bladder cancer surgery.
Materials and methods: This systematic review included randomized controlled trials investigating the effect of prehabilitation on postoperative outcomes in patients undergoing bladder cancer surgery. A comprehensive search was conducted, with two reviewers independently screening articles and extracting data. The Cochrane Collaboration’s tool was used to assess risk of bias, and GRADE to rate the quality of evidence. When possible, a random effects meta-analysis was conducted. Estimates were presented as risk ratios or mean differences with their 95% confidence intervals.
Results: Of the 2764 articles identified, five trials comprising 282 patients met the eligibility criteria. Prehabilitation modalities included preoperative exercise (3), preoperative nutrition (1), and multimodal (1). The mean age of patients ranged from 66.0 to 72.1 years. All included trials presented some or high risk of bias. Pooled analyses according to the different prehabilitation modalities demonstrated low to very low quality of evidence of no effect on postoperative complications and length of hospital stay.
Conclusion: This study revealed a small number of trials investigating the effectiveness of prehabilitation on patients undergoing bladder cancer surgery. Whether prehabilitation, including preoperative exercise, nutrition and multimodal interventions reduce postoperative morbidity and length of hospital stay following bladder cancer surgery is uncertain, as the quality of evidence is very low.

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