Prehabilitation and continuous perioperative rehabilitation for patients undergoing lung resection for non-small cell lung cancer: a structured narrative review.

BACKGROUND AND OBJECTIVE: Lung resection remains the primary curative treatment for early-stage non-small cell lung cancer (NSCLC), but surgery is associated with postoperative pulmonary complications (PPCs) and impaired functional recovery. Prehabilitation may improve physiologic reserve before surgery, although its effects on postoperative morbidity and sustained functional outcomes remain incompletely defined. This structured narrative review summarizes current evidence on prehabilitation and continuous perioperative rehabilitation before lung resection for NSCLC, with emphasis on early postoperative morbidity, functional recovery, and risk-adapted implementation. METHODS: This structured narrative review used a PICO-informed scope, structured literature search, and thematic synthesis. PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, eLibrary, and professional society websites were searched for English- and Russian-language publications from January 2019 through February 2026. Earlier landmark studies were considered when methodologically important or necessary for clinical context. Review-level evidence and primary studies were synthesized separately, focusing on PPCs, length of hospital stay (LOS), preoperative functional changes, recovery to baseline, postoperative between-group differences, and sustained functional outcomes at 6 months or later. KEY CONTENT AND FINDINGS: Evidence was most consistent for PPCs. The 2022 Cochrane review reported a reduced risk with preoperative exercise interventions (RR 0.45; 95% CI: 0.33 to 0.61), and a 2025 meta-analysis reported a similar association (RR 0.39; 95% CI: 0.25 to 0.60). A recent multicenter randomized trial in high-risk patients showed that a 14-day multimodal program reduced PPCs and shortened hospital stay. Functional outcomes varied according to timing, endpoint definition, baseline risk, and whether rehabilitation continued after surgery. Evidence for a sustained independent effect of the preoperative phase alone remains limited. CONCLUSIONS: Prehabilitation before lung resection for NSCLC is most consistently associated with improved early pulmonary outcomes. Continuous perioperative rehabilitation may be more relevant to sustained functional recovery than isolated preoperative intervention. A risk-adapted perioperative rehabilitation framework may be clinically useful, but should be regarded as an author-proposed approach requiring prospective validation.