Effects of enhanced recovery after surgery and prehabilitation interventions on postoperative outcomes after lung resection in patients with lung cancer: a systematic review and meta-analysis

IntroductionLung resection is the standard curative treatment for resectable lung cancer; however, postoperative pulmonary complications (PPCs) and prolonged hospital length of stay (LOS) remain major barriers to recovery and healthcare efficiency. Enhanced recovery after surgery (ERAS) and prehabilitation are distinct perioperative strategies that differ in their timing, intervention components, and mechanisms of action, but both aim to optimize patients’ perioperative condition and improve postoperative recovery. However, their effectiveness compared with conventional perioperative care based solely on randomized controlled trials (RCTs) has not been comprehensively synthesized.ObjectivesTo assess the effectiveness of ERAS and prehabilitation in reducing PPCs, shortening LOS, and improving patient-reported outcomes following pulmonary resection for lung cancer.Subjects and methodsWe conducted a systematic review and meta-analysis of RCTs involving adults undergoing pulmonary resection for primary lung cancer. Searches of PubMed, Embase, CENTRAL, CINAHL Complete, RISS, KISS, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform identified studies published between January 2015 and May 2026. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using GRADE. Random-effects meta-analyses estimated pooled odds ratios (ORs) for PPCs and mean differences (MDs) for LOS. Patient-reported outcomes were synthesized narratively according to the SWiM guideline.ResultsTen RCTs involving 1,569 participants met the inclusion criteria. ERAS and prehabilitation significantly reduced PPCs compared with conventional perioperative care (OR = 0.48, 95% CI = 0.36–0.65, p < 0.001). The exploratory pooled analysis suggested a shorter postoperative LOS (MD = −2.30 days, 95% CI = −3.58 to −1.01); however, heterogeneity was considerable (I2 = 97.9%), and the 95% prediction interval crossed the null. Narrative synthesis demonstrated consistent improvements in anxiety, depression, postoperative pain, pulmonary function, quality of life, and functional recovery.ConclusionERAS and prehabilitation are effective perioperative strategies for improving outcomes after pulmonary resection for lung cancer. Their implementation in routine clinical practice may reduce postoperative complications, accelerate recovery, and improve healthcare efficiency. Further multicenter RCTs are needed to optimize intervention components, standardize outcome measures, and strengthen evidence for long-term and patient-reported outcomes.Systematic review registrationCRD420261373242.