Prehabilitation prior to major cancer surgery: Training for surgery to optimize physiologic reserve to reduce postoperative complications

Purpose of Review The aging, sedentary global population and associated increasing incidence of cancer calls for increasingly complex surgery. These patients are at particular risk of postoperative complications. This review will explore the redesign of the perioperative care pathway, with emphasis on preoperative risk stratification to identify modifiable risk, to implement risk mitigation strategies (e.g., prehabilitation), and to partner with patients to enhance recovery after surgery. Recent Findings In the last decade, there has been a growing body of literature surrounding prehabilitation. A number of these studies report a staggering halving of postoperative complications. This body of literature requires perioperative medicine clinicians to appraise and build on the robustness of the data and to consider pragmatic strategies toward implementation of what appears to be a cost-effective intervention. Summary A redesign of perioperative care pathways with early risk stratification and implementing risk mitigation strategies is essential to delivering on the value proposition of healthcare. Challenges include a redesign of funding models to deliver such services, engaging patients with relatively remote access to such services, and the cultural trends of sedentary lifestyles and perceived urgency to have immediate surgery at all costs.