Prehabilitation and Early Recovery After Surgery (ERAS) in head and neck cancer patients undergoing surgery (PreERA)

This stratified randomized controlled trial evaluates the impact of a structured multidisciplinary prehabilitation program integrated with Enhanced Recovery After Surgery protocols on outcomes in patients undergoing elective head and neck cancer surgery with flap reconstruction. Adults aged from 18 years to 90 years with buccal mucosa carcinoma scheduled for bite composite resection will be randomized  to either standard perioperative care or a comprehensive prehabilitation program delivered for 2 weeks preoperatively. The intervention includes medical optimization, nutritional assessment and supplementation, anemia correction, structured physiotherapy, respiratory training, speech and swallowing therapy, and psychological counselling for stress and addiction management. ERAS components will be implemented perioperatively in both groups. The primary outcome is postoperative length of hospital stay. Secondary outcomes include postoperative morbidity , pulmonary complications, ICU stay, readmissions, mortality, functional recovery, nutritional status, speech and swallowing function, and behavioral modification. Outcomes will be assessed at baseline, preoperatively, discharge, and 90 days post-surgery. Data will be analyzed on an intention-to-treat basis using appropriate regression and mixed-effects modeling. This study aims to determine whether integrating prehabilitation with ERAS improves physiological reserve, accelerates recovery, and reduces complications compared with standard care in head and neck cancer surgery.