The impact of individualized short-term prehabilitation on perioperative complications and inflammatory markers in pancreaticoduodenectomy: a single-center historical cohort study.

BACKGROUND

Prehabilitation has emerged as a promising strategy to enhance physiological reserve and improve surgical outcomes. This study aimed to evaluate the impact of a short-term prehabilitation program on perioperative complications and inflammatory responses in patients undergoing pancreaticoduodenectomy (PD).

METHODS

Consecutive patients scheduled for PD between October 2024 and October 2025 were assessed for eligibility for the prehabilitation program. The intervention group underwent a minimum two-week, individualized, multimodal prehabilitation program involving physical exercise, nutritional optimization, and psychological support. A historical control cohort was established for comparison, comprising patients who underwent PD without prehabilitation between July 2023 to September 2024. Postoperative outcomes, including postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), length of hospital stay, readmission rates, mortality, and inflammatory markers (white blood cell count, C-reactive protein [CRP], and neutrophil -to-lymphocyte ratio[NLR]), were systematically recorded.

RESULTS

A total of 63 patients successfully completed the prehabilitation program. Significant improvements were observed in functional capacity, evidenced by increased 6-min walk distance (6MWD) (from 505.84 ± 65.95 m to 546.30 ± 56.49 m; p < 0.05) and forced expiratory volume in 1 s (FEV1%) (from 76.44 ± 4.27% to 81.23 ± 3.86%; p < 0.05). Quality of life (QoL) scores, assessed by the SF-36 questionnaire, also demonstrated significant enhancement. Compared to the control group, the prehabilitation group exhibited a attenuated systemic inflammatory response, with significantly lower white blood cell counts, CRP levels, and NLR on postoperative days 1 and 3 (p < 0.05). No statistically significant differences in the rates of clinical complications-including POPF, pleural effusion, intra-abdominal infection, reoperation, and Clavien-Dindo grade ≥III complications-were observed between the prehabilitation group and the control group, either before or after 1:1 propensity score matching (all p > 0.05). Supplementary analysis of the intervention cohort found no significant differences in postoperative outcomes between full-adherence (n = 40) and moderate-adherence (n = 23) subgroups (p > 0.05).

CONCLUSION

Short-term prehabilitation attenuates the perioperative blood cell and CRP response and improves functional capacity and quality of life, but it does not significantly reduce postoperative complication rates in this cohort.