{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T18:54:41Z","timestamp":1792522481946,"version":"4.5.0"},"reference-count":33,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"\n Importance<\/jats:title>\n Sarcopenia is an emerging predictor of complications after liver surgery. Strategies to mitigate its impact are crucial to improving postoperative outcomes.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether a 6-week multimodal prehabilitation program combining physical exercise and nutritional support reduces postoperative morbidity in patients with sarcopenia who are undergoing major hepatectomy.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This study is a single-center, open-label, randomized clinical trial conducted from April 2022 to January 2025. Adult patients with sarcopenia scheduled for major liver resection and requiring future liver remnant hypertrophy were randomized (1:1) to receive either structured prehabilitation or standard care. The trial was conducted in a tertiary hepatobiliary referral center in Italy. Enrolled adult patients had radiologically and functionally confirmed sarcopenia. Most patients underwent portal vein embolization and right hepatectomy.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n The intervention group received a 6-week program while awaiting future liver remnant hypertrophy including daily walking, supervised biweekly in-hospital exercise, and branched-chain amino acid and immune nutritional supplementation. The control group received standard perioperative care.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was 90-day postoperative morbidity, assessed by Clavien-Dindo classification.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 70 adult patients with radiologically and functionally confirmed sarcopenia were enrolled, and 60 (median [IQR] age, 69 [63-75] years; 32 male [53.3%]) were included in the final analysis. Most patients (52 [86.7%]) underwent portal vein embolization, and 63 (88.3%) underwent right hepatectomy. Overall morbidity was significantly lower in the prehabilitation group (4 of 30 [13.3%] vs 15 of 30 [50%]; odds ratio, 0.15; 95% CI, 0.04-0.55;\n P<\/jats:italic>\n \u2009=\u2009.004), with an absolute risk reduction of 36.7% and number needed to treat of 3. All major complications occurred in the control group (6 of 30 [20%];\n d<\/jats:italic>\n = 0.40;\n P<\/jats:italic>\n \u2009=\u2009.02). Muscle mass and strength improved significantly only in the prehabilitation arm.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Results of this randomized clinical trial reveal that a 6-week structured prehabilitation program significantly reduced postoperative morbidity in patients with sarcopenia undergoing major liver resection. These findings support integrating exercise and nutritional interventions into preoperative care for high-risk surgical patients to improve surgical outcomes.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05281211<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2025.3102","type":"journal-article","created":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:31:15Z","timestamp":1756308675000},"page":"1068","source":"Crossref","is-referenced-by-count":48,"title":["Prehabilitation With Exercise and Nutrition to Reduce Morbidity of Major Hepatectomy in Patients With Sarcopenia"],"prefix":"10.1001","volume":"160","author":[{"given":"Giammauro","family":"Berardi","sequence":"first","affiliation":[{"name":"Department of General, Hepatobiliary and Pancreatic Surgery, Transplantation Unit, Department of General Surgery, San Camillo Forlanini Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Cucchetti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum, Universit\u00e0 di Bologna, Morgagni-Pierantoni Hospital, Forl\u00ec, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Colasanti","sequence":"additional","affiliation":[{"name":"Department of General, Hepatobiliary and Pancreatic Surgery, Transplantation Unit, Department of General Surgery, San Camillo Forlanini Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Angrisani","sequence":"additional","affiliation":[{"name":"Department of General, Hepatobiliary and Pancreatic Surgery, Transplantation Unit, Department of General Surgery, San Camillo Forlanini Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Moschetta","sequence":"additional","affiliation":[{"name":"Department of General, Hepatobiliary and Pancreatic Surgery, Transplantation Unit, Department of General Surgery, San Camillo Forlanini Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Chiappori","sequence":"additional","affiliation":[{"name":"Department of General, Hepatobiliary and Pancreatic Surgery, Transplantation Unit, Department of General Surgery, San Camillo Forlanini Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Marini","sequence":"additional","affiliation":[{"name":"Department of General, Hepatobiliary and Pancreatic Surgery, Transplantation Unit, Department of General Surgery, San Camillo Forlanini Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulio","family":"Antonelli","sequence":"additional","affiliation":[{"name":"Gastroenterology and Digestive Endoscopy Unit, Ospedale dei Castelli, Ariccia, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Ferretti","sequence":"additional","affiliation":[{"name":"Department of General, Hepatobiliary and Pancreatic Surgery, Transplantation Unit, Department of General Surgery, San Camillo Forlanini Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto Luca","family":"Meniconi","sequence":"additional","affiliation":[{"name":"Department of General, Hepatobiliary and Pancreatic Surgery, Transplantation Unit, Department of General Surgery, San Camillo Forlanini Hospital, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Guglielmo","sequence":"additional","affiliation":[{"name":"Department of 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