Evidence summary: Prehabilitation strategies for patients with primary liver cancer.

OBJECTIVE

To synthesise and appraise current evidence on prehabilitation strategies for patients with primary liver cancer.

METHODS

Using the PIPOST framework, we formulated clinical questions and defined eligibility criteria. Guided by the "5S" evidence hierarchy, a comprehensive search was conducted across 20 sources-including clinical decision systems, guideline repositories, bibliographic databases, and professional society websites-from inception to 1 December 2024. Two independent reviewers screened and appraised eligible studies, and evidence synthesis was limited to those meeting predefined quality standards. Nine experts evaluated the evidence through a structured consensus process based on the FAME framework to determine recommendation grades.

RESULTS

Twenty studies were included: 1 clinical decision tool, 5 guidelines, 5 systematic reviews, 5 expert consensuses, 3 evidence summaries, and 1 randomised controlled trial. A total of 36 evidence statements were extracted and categorised into six domains: prehabilitation candidates, timing of prehabilitation, nutritional optimisation, physical exercise, psychological support, and health education. Although part of the evidence originated from non-liver cancer populations, extrapolation was considered reasonable due to shared pathophysiological risks across major abdominal surgeries. Of these, 34 evidence statements received strong recommendations after expert appraisal.

CONCLUSIONS

This study consolidates practical, evidence-based prehabilitation strategies for patients with primary liver cancer, while underscoring the cautious use of extrapolated evidence where liver cancer-specific data are lacking. Despite methodological rigour, conclusions remain constrained by the limited availability of liver cancer-focused studies. Future research should generate direct evidence to refine prehabilitation protocols. Clinical application should integrate both the best available evidence and patient preferences.

SYSTEMATIC REVIEW REGISTRATION: Registered with the Fudan University Evidence-based Nursing Centre (ID: ES20246474).