The literature evaluating the effect of prehabilitation programmes on postoperative outcomes and quality of life of patients with gynaecological cancer undergoing surgery was reviewed. Databases including Pubmed, Medline, EMBASE (Ovid) and PsycINFO were systematically searched to identify studies evaluating the effect of prehabilitation programmes on patients with gynaecological cancer. Both unimodal and multimodal prehabilitation programmes were included encompassing physical exercise and nutritional and psychological support. Primary outcomes were surgical complications and quality of life. Secondary outcomes were anthropometric changes and adherence to the prehabilitation programme. Seven studies fulfilled the inclusion criteria, comprising 580 patients. Included studies were nonrandomised prospective studies (n = 4), retrospective studies (n = 2) and one case report. Unimodal programmes and multimodal programmes were included. In patients with ovarian cancer, multimodal prehabilitation resulted in significantly reduced hospital stay and time to chemotherapy. In patients with endometrial and cervical cancer, prehabilitation was associated with significant weight loss, but had no significant effects on surgical complications or mortality. No adverse events of the programmes were reported. Evidence on the effect of prehabilitation for patients with gynaecological cancer is limited. Future studies are needed to determine the effects on postoperative complications and quality of life.

The objective was to review the literature on the effect of surgical cytoreduction in recurrent endometrial cancer on survival, and identify baseline and clinical factors associated with improved survival. In addition, we sought to assess the effect of previous radiotherapy on surgical achievement. This review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We performed a search of PubMed and Cochrane Library to identify studies comparing cytoreductive surgery to medical management and studies reporting on patients receiving cytoreductive surgery as part of multi-modal treatment. Primary outcomes included overall survival and progression free survival, secondary outcomes included factors associated with improved survival. A total of 11 studies fulfilled the inclusion criteria, comprising 1146 patients. All studies were retrospective studies. Cytoreduction as part of treatment for recurrent endometrial cancer was associated with prolonged overall survival and progression free survival. Complete cytoreduction was an independent factor associated with improved survival. Other factors associated with prolonged survival were tumor grade 1, endometrioid histology, ECOG performance status 0, and isolated pelvic recurrences. Factors associated with obtaining complete cytoreduction included solitary disease, tumor size <6 cm and ECOG performance status 0. Previous radiotherapy was not associated with achieving complete cytoreduction. Cytoreductive surgery may benefit patients meeting specific selection criteria based on a limited number of retrospective studies, with complete cytoreduction showing the largest survival gain. However, further prospective studies are needed to validate the survival benefit and aid in patient selection.

Prehabilitation is an upcoming strategy to optimize patient’s functional capacity, nutritional status, and psychosocial well-being in order to reduce surgical complications and enhance recovery. This study aims to assess the feasibility of implementing a multimodal prehabilitation program into the standard care of gynecological oncology patients at an academic hospital in terms of recruitment, adherence, and safety, which were assessed by the number of patients eligible, recruitment rate, participation rate, and adherence to individual modalities. Data were derived from the F4S PREHAB trial, a single-center stepped-wedge trial implementing a multimodal prehabilitation program among various surgical specialties. All patients undergoing elective surgery as part of treatment for ovarian, uterine, and vulvar cancer at the Radboudumc, an academic hospital in The Netherlands, between May 2022 and September 2023 were considered eligible for the F4S PREHAB trial and, consequently, were included in this cohort study. The multimodal prehabilitation program comprised a physical exercise intervention, nutritional intervention, psychological intervention, and an intoxication cessation program. A total of 152 patients were eligible and approached for participation of which 111 consented to participate, resulting in a recruitment rate of 73%. Participants attended an average of six exercise sessions and adhered to 85% of possible training sessions. Respectively, 93% and 98% of participants adhered to the prescribed daily protein and vitamin suppletion. Ten participants were referred to a psychologist and completed consultations. Out of nine active smokers, two managed to quit smoking. A total of 59% adhered to alcohol cessation advice. No adverse events were reported. This study demonstrates that introducing a multimodal prehabilitation program into the standard care of gynecological oncology patients is feasible in terms of recruitment and adherence, with no serious adverse events.

Surgical treatment for gynaecological malignancies is still associated with high postoperative morbidity. Multimodal prehabilitation may improve functional capacity and thereby reduce surgical-related morbidity. Therefore, this study aims to assess the effect of multimodal prehabilitation on physical fitness and nutritional status of gynaecological oncology patients. Within the F4S-PREHAB trial, a stepped-wedge trial assessing the effect of multimodal prehabilitation comprising exercise, nutrition, psychological support and intoxication cessation, a subgroup analysis was performed in women with gynaecological cancer undergoing surgery between May 2022 and April 2024 at the Radboudumc, Nijmegen. Physical fitness was compared before and after participation using estimated peak oxygen uptake, muscle strength (indirect 1-Repetition Maximum (1-RM) leg press), handgrip strength and Five-times Chair-Stand-Test. In addition, nutritional status was assessed through risk of malnutrition assessments. Further outcomes include the effect on body composition and biomarkers (Haemoglobin, Leukocytes, C-Reactive Protein, Albumin). In total, 140 women underwent the prehabilitation programme. Significant improvements were observed in VO2peak with 8 % (P = 0.001), 1-RM leg press with 20 % (p < 0.001) and Five-times Chair-Stand-Test with 0.5 s (p = 0.001). The number of patients at moderate to high risk of malnutrition significantly decreased after the programme, from 29 % to 19 % (p = 0.001). No changes in body composition and biomarkers were found. This study demonstrates that multimodal prehabilitation has the ability to improve physical fitness and nutritional status preoperatively in gynaecological oncology patients. Further studies are needed to define the role of prehabilitation in improving physical fitness and nutritional status, and its association with postoperative outcomes, allowing for more personalized and effective treatment.