Multimodal prehabilitation before major liver resection in people with sarcopenia

Evidence label: Positive single-center randomized complication signal · Clinical goal: reduce postoperative morbidity before major liver resection

Evidence at a glance

Population: 70 adults with radiologically and functionally confirmed sarcopenia; 60 were included in the final analysis.
Intervention: six weeks of daily walking, twice-weekly supervised exercise and nutritional supplementation while awaiting future-liver-remnant hypertrophy.
Result: 90-day postoperative morbidity was 13.3% with prehabilitation and 50.0% with standard care.

What was studied

PREHEP was an open-label, single-center randomized trial in a selected high-risk liver-surgery population. Most participants underwent portal-vein embolization and right hepatectomy. The primary outcome was 90-day morbidity by Clavien–Dindo classification.

What the evidence shows

Overall postoperative morbidity was lower with the six-week program (13.3% versus 50.0%; P=.004). This is clinically important but applies to a multimodal package: walking and supervised exercise were combined with branched-chain amino acid and immunonutrition supplements.

The trial tested surgical complications, not tumor response, recurrence or survival. It also cannot identify which component produced the observed difference.

Limits and uncertainty

Ten randomized participants were not in the final analysis, the trial was small and unblinded, and the highly selected sarcopenic population limits generalizability. Nearly all participants underwent major right-sided resection after a hypertrophy strategy. Component-specific effects and longer-term outcomes remain uncertain.

Safety and practical context

Prehabilitation must not delay cancer surgery or compromise nutrition. Liver disease, portal-vein procedures, frailty, falls and cardiopulmonary status may require adaptation. New jaundice, fever, bleeding, severe abdominal pain or functional decline needs surgical-team review.

Questions for the care team

Does my planned operation and sarcopenia profile resemble the PREHEP population?
Would exercise and nutrition be coordinated as one supervised program?
Could prehabilitation delay surgery, and what stop date or milestones apply?

Sources

Literature searched: October 22, 2026 · Record appraised: October 22, 2026

Educational evidence summary, not personal medical advice. Research regimens describe what was studied; they are not personal prescribing instructions and should not replace cancer treatment or individualized supportive care.