Annals of Surgical Oncology

, Volume 26, Issue 1, pp 264–272 | Cite as

Clinical Benefit of Preoperative Exercise and Nutritional Therapy for Patients Undergoing Hepato-Pancreato-Biliary Surgeries for Malignancy

  • Hiroki Nakajima
  • Yukihiro YokoyamaEmail author
  • Takayuki Inoue
  • Motoki Nagaya
  • Yota Mizuno
  • Izumi Kadono
  • Kimitoshi Nishiwaki
  • Yoshihiro Nishida
  • Masato Nagino
Hepatobiliary Tumors



The impact of prehabilitation on physical fitness and postoperative course after hepato-pancreato-biliary (HPB) surgeries for malignancy is unknown. The current study aimed to investigate the effect of preoperative exercise and nutritional therapies on nutritional status, physical fitness, and postoperative outcomes of patients undergoing an invasive HPB surgery for malignancy.


Patients who underwent open abdominal surgeries for HPB malignancies (major hepatectomy, pancreatoduodenectomy, or hepato-pancreatoduodenectomy) between 2016 and 2017 were subjected to prehabilitation. Patients before the introduction of prehabilitation were included as historical control subjects for 1:1 propensity score-matching (no-prehabilitation group). The preoperative nutritional status and postoperative course were compared between the two groups.


The prehabilitation group consisted of 76 patients scheduled to undergo HPB surgeries for malignancy. An identical number of patients were selected as the no-prehabilitation group after propensity score-matching. During the waiting period, serum albumin levels were significantly deteriorated in the no-prehabilitation group, whereas this index did not deteriorate or even improved in the prehabilitation group. By performing prehabilitation, a 6-min walk distance and total muscle/fat ratio were significantly increased during the waiting period. Although the overall incidence of postoperative complications did not differ between the two groups, the postoperative hospital stay was shorter in the prehabilitation group than in the no-prehabilitation group (median, 23 vs 30 days; p = 0.045).


The introduction of prehabilitation prevented nutritional deterioration, improved physical fitness before surgery, and shortened the postoperative hospital stay for the patients undergoing HPB surgeries for malignancy.



This work was supported in part by Grants-in-Aid for Scientific Research (no. 16K21081 to T. Inoue) from the Ministry of Education, Culture, Sports, and Science and Technology of Japan. We sincerely thank all the patients, collaborating physicians, and other medical staff for their important contributions to this study.


The authors affirm that they have no financial or personal affiliations (including research funding) or other involvement with any commercial organization that has a direct financial interest in any matter included in this manuscript.

Supplementary material

10434_2018_6943_MOESM1_ESM.pdf (123 kb)
FIG. S1 Flow chart of the study participants. (PDF 122 kb)
10434_2018_6943_MOESM2_ESM.pdf (69 kb)
FIG. S2 Correlation between the serum albumin and the 6-min walk distance (6MWD) at the second hospitalization. The correlation between the two variables was determined by Spearman’s rank correlation coefficient. (PDF 69 kb)
10434_2018_6943_MOESM3_ESM.docx (12 kb)
Supplementary material 3 (DOCX 12 kb)


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Hiroki Nakajima
    • 1
  • Yukihiro Yokoyama
    • 2
    Email author
  • Takayuki Inoue
    • 1
  • Motoki Nagaya
    • 1
  • Yota Mizuno
    • 1
  • Izumi Kadono
    • 1
    • 3
  • Kimitoshi Nishiwaki
    • 4
  • Yoshihiro Nishida
    • 1
    • 3
  • Masato Nagino
    • 2
  1. 1.Department of RehabilitationNagoya University HospitalNagoyaJapan
  2. 2.Division of Surgical Oncology, Department of SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  3. 3.Department of Orthopedic SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  4. 4.Department of AnesthesiologyNagoya University Graduate School of MedicineNagoyaJapan

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