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Role and impact of multimodal prehabilitation for gynecologic oncology patients in an Enhanced Recovery After Surgery (ERAS) program
  1. Ester Miralpeix1,
  2. Gemma Mancebo1,
  3. Sonia Gayete1,
  4. Marta Corcoy2 and
  5. Josep-Maria Solé-Sedeño1
  1. 1Department of Obstetrics ad Gynecology, Hospital del Mar, Barcelona, Spain
  2. 2Department of Anesthesia, Hospital del Mar, Barcelona, Spain
  1. Correspondence to Mrs Ester Miralpeix, Department of Obstetrics and Gynecology, Hospital del Mar, Barcelona E-08003, Spain; ester.miralpeix{at}


Patients undergoing major surgery are predisposed to a decrease in functional capacity as a response to surgical stress that can delay post-operative recovery. A prehabilitation program consists of patient preparation strategies before surgery, and include pre-operative measures to improve functional capacity and enhance post-operative recovery. Multimodal prehabilitation may include exercise, nutritional counseling, psychological support, and optimization of underlying medical conditions, as well as cessation of unfavorable health behaviors such as smoking and drinking. Currently, there are no standardized guidelines for prehabilitation, and the existent studies are heterogeneous; however, multimodal approaches are likely to have a greater impact on functional outcomes than single management programs. We have reviewed the literature on prehabilitation in general, and in gynecologic surgery in particular, to identify tools to establish an optimal prehabilitation program within an Enhanced Recovery After Surgery (ERAS) protocol for gynecologic oncology patients. We suggest a safe, reproducible, functional, and easy-to-apply multimodal prehabilitation program for gynecologic oncology practice based on patient-tailored pre-operative medical optimization, physical training, nutritional counseling, and psychological support. The analysis of the prehabilitation program implementation in an ERAS protocol should undergo further research in order to test the efficacy on surgical outcome and recovery after surgery.

  • Postoperative complications
  • Surgical Oncology
  • Postoperative Care
  • Preoperative Care
  • Surgery

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  • Contributors EM, MC and GM conceived the idea for the study. EM, JMS and GM established the methodology. EM and SG wrote the article and conducted the literature examination. All authors were responsible for the writing, critical review, and final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.