Identifying the Need for Prehabilitation in Cancer Patients Undergoing Nephrectomy or Nephroureterectomy

Abstract

Background: The potential benefits of prehabilitation in patients undergoing surgery for renal cell carcinoma (RCC) or upper-tract urothelial carcinoma (UTUC) remain unknown. The aim was to evaluate physical function and baseline characteristics over the course of treatment to identify a potential need for prehabilitation. Methods: In this prospective observational study, 62 patients were enrolled—31 undergoing nephrectomies for RCC and 31 undergoing nephroureterectomy for UTUC. Baseline assessments included nutritional screening (NRS 2002), frailty (Clinical Frailty Scale), hemoglobin and iron levels, smoking status, and physical function using the Six-Minute Walk Test (6MWT) and the 30-Second Sit-to-Stand Test (30STS). Functional tests were repeated at hospital discharge and at two-week postoperative follow-up visit. Results: At baseline, 45% of RCC and 68% of UTUC patients were at nutritional risk. Preoperative frailty was present in 20% of the cohort, and 53% had anemia. Functional impairment below the lower limit values (LLVs) was observed in 16% for the RCC and 36% of the UTUC, assessed by 6MWT. The 30 STS revealed that 58% of RCC and 42% of UTUC were below LLV. At discharge, impairment peaked, with 59% and 82% of patients being below the LLVs, respectively. Functional performance partially recovered at follow-up but did not return to baseline levels. Conclusions: Preoperative nutritional deficits, anemia, and functional impairment are prevalent in patients undergoing nephrectomy or nephroureterectomy. A marked postoperative functional decline was identified postoperatively supporting a potential need for early individualized prehabilitation strategies to improve recovery in patients undergoing kidney cancer surgery.