Background and Objective: Evaluating the effects of nutritional prehabilitation on postoperative
complications in patients with esophageal cancer can not only contribute to optimizing clinical outcomes but
also represents a key step toward evidence-based care and reducing variability in current treatment
practices. This systematic review and meta-analysis aimed to critically analyze the existing evidence
regarding the impact of preoperative nutrition-based prehabilitation on the severity of postoperative
complications in patients with esophageal cancer.
Materials & Methods: This systematic review and meta-analysis, conducted in accordance with
PRISMA guidelines, aimed to assess the effects of preoperative nutrition-based prehabilitation—with or
without adjunctive physical and psychological interventions—on the severity of postoperative complications
in patients with esophageal cancer. A comprehensive literature search was conducted in five international
and two Iranian databases up to September 2025. Only randomized controlled trials (RCTs) were included.
Nutritional prehabilitation was defined as the administration of oral supplements or enteral nutrition for a
minimum of 7 days, and some studies also incorporated physical training and psychological support. Data
extraction, quality assessment, and statistical analyses were performed independently by two reviewers.
Risk ratios (RR), weighted mean differences (WMD), and I² statistics for heterogeneity were used for data
synthesis. Analyses were conducted using RevMan software, and a p-value of <0.05 was considered
statistically significant.
Results: Five RCTs involving a total of 405 patients were included in this systematic review and metaanalysis.
The pooled analysis demonstrated a significant reduction in the incidence of severe postoperative
complications in favor of preoperative nutritional prehabilitation (RR = 0.66, 95% CI: 0.48–0.92). Similarly, a
comparable reduction was observed in studies employing multimodal prehabilitation (RR = 0.69, 95% CI:
0.49–0.97).
Conclusion: The findings of this systematic review and meta-analysis suggest that preoperative
nutrition-based prehabilitation—particularly when implemented as part of a multimodal program—can
effectively reduce the severity of postoperative complications in patients undergoing surgery for esophageal
cancer. Nutritional interventions should be considered an essential component of preoperative care in this
patient population.