Impact of multimodal prehabilitation as part of ERAS on surgical outcomes in high-risk advanced ovarian cancer patients undergoing primary cytoreduction without HIPEC

Background. Ovarian cancer is one of the most lethal gynecological malignancies. Primary cytoreductive surgery remains the standard treatment, but in high-risk patients the complication rate is substantial. Multimodal prehabilitation within ERAS protocols is a promising approach to optimize patients’ condition before surgery. The purpose was to evaluate the impact of multimodal prehabilitation on perioperative outcomes in patients with advanced ovarian cancer undergoing primary cytoreduction. Materials and methods. In this prospective observational study (2022–2024), 150 patients with FIGO stage IIIC–IV ovarian cancer and ASA III–IV status were included. Seventy-five patients completed a 7–14-day prehabilitation program (nutritional support, anemia correction, exercise, psychological counseling), while 75 historical controls received standard ERAS care only. Primary endpoints were postoperative complications; secondary endpoints included hospital stay and time to chemotherapy initiation. Results. Prehabilitation significantly improved nutritional and functional parameters, reduced hospital stay (8 vs. 14 days; p < 0.005), accelerated chemotherapy initiation (8 vs. 15 days; p < 0.005), lowered the incidence of severe complications and 30-day mortality (1 vs. 10 %). Optimal benefit was achieved with ~ 10-day programs. Conclusions. Multimodal prehabilitation improves functional status, reduces morbidity, and shortens recovery in patients with advanced ovarian cancer, supporting its integration into ERAS pathways.