Perioperative exercise and post-operative mortality in patients undergoing oncologic surgery: a systematic review and meta-analysis

Abstract

Purpose: To evaluate the potential impact of perioperative exercise on survival and post-operative mortality in oncologic patients undergoing surgical resection. Methods: A systematic review of randomized controlled trials administering perioperative exercise in oncologic patients undergoing surgical resection published between 2000 and 2024 was performed. Embase, PubMed, Web of Science, and the Cochrane Library were searched, and outcomes of interest included recurrence-free survival, disease-free survival, cancer-specific survival, overall survival, or post-operative mortality. Results: Of the 806 articles identified, 5 met inclusion criteria, representing 650 oncologic patients receiving pulmonary (n = 2), hepatobiliary (n = 1), gastroesophageal (n = 1), and colorectal surgeries (n = 1). Of the 650 patients, 330 were randomized to a perioperative exercise intervention. Perioperative exercise was generally administered pre-operatively (n = 4), ranged in duration from 2 weeks (n = 1) to 3 months (n = 1) and ranged from low (n = 1) to high (n = 1) intensity. The types of exercise regimens included walking (n = 5), cycling (n = 4), or jogging (n = 2) either alone or in combination with nutritional and psychosocial support. In all studies, perioperative exercise improved indices of cardiorespiratory fitness. However, perioperative exercise improved disease-free survival in only one study, and post-operative mortality did not differ between perioperative exercise and control groups. Conclusion: In the reviewed studies, the use of perioperative exercise enhanced physical fitness, but did not show a significant effect on post-operative mortality. However, survival was the primary endpoint for only one of the included studies and the type of exercise regimen varied widely. Thus, our findings are limited by its sample size and highlight the lack of uniformity in perioperative exercise regimens and the need for future trials to be powered to determine the effect of exercise on long-term oncologic endpoints.