Preparing for surgery

As you prepare for surgery, talk with your oncology and surgical teams about ways to build your resilience.

On this page:

How can preparing for surgery help me?

The state of your general health can have a huge impact on your ability to respond to and recover from surgery. Better general health and resilience can prevent or reduce some of the complications of surgery. Time invested before surgery can speed your recovery, improve your quality of life, and perhaps improve your cancer outcomes.

A few body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation and more factors are known to interact with surgery.

We are still researching terrain factors; these assessments are from our work so far.

Blood sugar and insulin resistance

Blood sugar and insulin resistance: High blood sugar during or after surgery is linked to worse outcomes:

  • Higher risk of infection and other complications, including short-term mortality, after surgery among people with poor glycemic control and/or insulin resistance (modest evidence)
  • Longer hospital and/or intensive care unit (ICU) stays after surgery among people with diabetes with poor glycemic control (modest evidence)

If you have high blood sugar or diabetes, talk to your doctor about how to safely lower your blood sugar before surgery.

Body composition

Loss of muscle tissue (sarcopenia) is linked to higher risk of worse outcomes after surgery: 

  • Higher risk of complications after surgery among people with loss of muscle tissue or poor cardiopulmonary fitness before surgery (good evidence)
  • Longer hospital stays after surgery among people with colorectal cancer with low skeletal muscle mass and density (modest evidence)
  • Much better survival among people with colorectal cancer with greater muscle density after diagnosis or before surgery (preliminary evidence)

Body weight

Risks of poor outcomes related to surgery are higher among people with excess body weight. 

  • Substantially higher risk of blood clots after surgery among women with body mass index (BMI) of 25 or higher (good evidence)
  • Longer surgery times, higher illness (morbidity) after surgery, higher conversion to surgery and to open surgery, and higher risk of infection and other complications related to surgery among people who are obese (good evidence)
  • Higher risk of surgical site infection among people who are obese (modest evidence)

If you are planning surgery to treat cancer, you may not have time to lose a lot of weight before your procedure, but even a few pounds can improve your outcomes. Even if you are not able to lower your weight, we encourage you to ask your oncology and surgical teams what you can do to improve your health and optimize your surgical outcomes.

Expert approach: Lise Alschuler, ND, FABNO, and Karolyn Gazella 

BCCT advisor Lise Alschuler, ND, FABNO, and her co-author Karolyn Gazella list five key body pathways to target in making your body less hospitable to cancer. Four of those pathways most relevant to prevention or management of surgical complications are the immune system, insulin resistance, inflammation, and hormonal balance (including stress hormones). Their books describe key actions to balance these pathways.

Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010. Chapters 8-11

Alschuler LN, Gazella KA. The Definitive Guide to Thriving after Cancer: A Five-Step Integrative Plan to Reduce the Risk of Recurrence and Build Lifelong Health. Berkeley, California: Ten Speed Press. 2013. Chapters 1-5

Prehabilitation: preparing your body for surgery

Similar to rehabilitation after injury, “prehabilitation” optimizes your health and function before surgery. Through nutrition, exercise, and managing anxiety, prehabilitation (prehab) gets you into better shape. Prehab can help your body deal with the impact of surgery.1Lambert JE, Hayes LD, Keegan TJ, Subar DA, Gaffney CJ. The impact of prehabilitation on patient outcomes in hepatobiliary, colorectal, and upper gastrointestinal cancer surgery: a PRISMA-accordant meta-analysis. Annals of Surgery. 2021 Jul 1;274(1):70-77. Time spent building your physical and emotional reserves before surgery is an investment that can pay you back during recovery. 

Research shows these benefits of prehab: 

Enhanced recovery after surgery (ERAS) 

A prehabilitation protocol called enhanced recovery after surgery (ERAS) is linked to these outcomes: 

ERAS in combination with other therapies

ERAS with an integrated traditional Chinese and Western medicine approach is linked to lower markers of inflammation (CRP, IL-6, IL-8, and TNF-β) and stress (cortisol), lower reported pain, and earlier defecation after surgery among people with gastrointestinal tumors (preliminary evidence).15Zhao H, Sun W. Effect of enhanced recovery after surgery with integrated traditional Chinese and western medicine on postoperative stress response of patients with gastrointestinal tumors. Computational and Mathematical Methods in Medicine. 2022 Jul 8;2022:3663246.

Ask if your surgical team uses this approach. More about ERAS is in the Are you a health professional? page of this handbook.

Self care

7 Healing Practices

Each of the 7 Healing Practices can build your health. Eating Well and Moving More have been studied specifically in preparing for surgery.

Eating Well

If you are malnourished, addressing your nutrition before surgery is especially important. Ask your care team to assess your nutritional needs before surgery to determine a nutrition plan before and after surgery.

See Eating Well for more information about making food choices to promote your health.

Moving More: mixed evidence

Increased activity before surgery can improve your recovery and reduce your surgical risks. 

More rapid recovery from surgery, shorter hospital stays, and substantially fewer complications from surgery among people participating in exercise training before surgery (good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (randomized controlled trials (RCTs) with an appropriate placebo or other strong comparison control or observational studies that control for confounds) (this is the CancerChoices definition; other researchers and studies may define this differently))

Improved muscle mass among people participating in exercise before surgery
(preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently)); this can reduce your risks related to low muscle mass or density, described above in Body composition.

Expert approach: Barbara MacDonald, ND, FABNO

MacDonald B. The Breast Cancer Companion—A Complementary Care Manual: Third Edition. Self-published. 2016.

Naturopathic physician Barbara MacDonald provides information about breast cancer, its conventional treatment, and natural approaches to enhancing treatment, managing side effects, reducing risk of recurrence, and healthy living after cancer treatment is completed.

Dr. MacDonald recommends an anti-inflammatory diet high in vegetables, fruits, grains, and healthy protein. Dr. MacDonald suggests following this diet for at least two weeks before surgery unless your care team advises otherwise due to any food allergies or your specific nutritional needs.

Natural products, medications, and surgery

Before your surgery, your surgeon and anesthesiologist will need to know what medications, supplements, and natural products you’re taking.

You may be told to quit eating and drinking several hours before your surgery, but you may still need to take certain medications. Your doctors will tell you which ones to take with a small amount of water. If you are on an ERAS protocol (mentioned above), you might be asked to drink a high carbohydrate drink a few hours before surgery.)

Sometimes doctors forget to ask about any supplements and vitamins you take. If they don’t ask, you need to tell them. Your entire team needs to know about any natural products or supplements you are taking. 

Both drugs and natural products can have effects that could be harmful in surgery or during your recovery. Examples:16Hodges PJ, Kam PC. The peri-operative implications of herbal medicines. Anaesthesia. 2002 Sep;57(9):889-99.

  • Anticoagulants—drugs and supplements that reduce coagulation, commonly called “blood thinners”—can increase your risk of serious bleeding.
  • Drugs or supplements with sedative effects may interact with your anesthesia or sedatives and delay your wake-up time after surgery.
  • Some products might interfere with your ability to clear the anesthesia and other drugs from your system.
  • Other products might suppress your immune system.

Many more interactions are possible. The American Society of Anaesthesiologists advises patients to stop taking herbal medicines at least two weeks before surgery.17Hodges PJ, Kam PC. The peri-operative implications of herbal medicines. Anaesthesia. 2002 Sep;57(9):889-99. Several prescription and over-the-counter medications may also need to be stopped before surgery. Follow your medical team’s directions.

Keep an up-to-date list of all the medications, vitamins, and supplements you are taking and your doses. You can keep a notebook to record this information, or you can use one of several phone apps. Ask your team if you have questions about any medication you are taking or they prescribe. 

Medications to avoid before surgery

We strongly encourage you to talk with your oncology and surgical teams before stopping any medications you have been prescribed

Some examples of medications your doctor may ask you to stop before surgery; this is not a complete list: 

Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) including celecoxib (Celebrex), ibuprofen (Motrin, Advil), and naproxen (Aleve, Anaprox, Naprelan, Naprosyn)

Metformin 

Steroids 

Some types of blood pressure medications (ACE Inhibitors)

Others (listed on MedicineNet)

Blood thinners 

  • Apixaban (Eliquis)
  • Dabigatran (Pradaxa) 
  • Dalteparin (Fragmin) 
  • Edoxaban (Savaysa)
  • Enoxaparin (Lovenox) 
  • Fondaparinux (Arixtra) 
  • Heparin (Innohep) 
  • Rivaroxaban (Xarelto) 
  • Warfarin (Coumadin, Jantoven)

Natural products to avoid before surgery

Discontinue two weeks before surgery

Avoid taking the following natural product supplements that increase your risk of bleeding:18MacDonald B. The Breast Cancer Companion: A Complementary Care Manual: Third Edition. (self-published, Amazon, 2016); Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.

Alfalfa

Astragalus ›

Bromelain

Capsicum

Devil’s claw

Dong quai (Angelica sinensis)

Ginkgo biloba

Ginseng

Essential fatty acids (EFAs):

Goji berries

Green tea capsules ›

Licorice

Red clover

Sage

Turmeric (curcumin) (quantities used in cooking are not a concern)

Vitamin E ›

Vitamin K

Willow bark

Discontinue five to ten days before surgery

Stop cleansing and detoxification regimens and stop taking natural products that affect your liver’s ability to clear anesthesia, sedatives, pain medications, and other surgical drugs. Unless your doctor advises you to take melatonin, discontinue use to avoid magnifying the effects of anesthesia.19MacDonald B. The Breast Cancer Companion: A Complementary Care Manual: Third Edition. (self-published, Amazon, 2016); Alschuler LN, Gazella KA. The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing. Berkeley, California: Celestial Arts. 2010; Block KI. Life over Cancer: The Block Center Program for Integrative Cancer Treatment. New York: Bantam Dell. 2009.

Garlic

Grapefruit juice

Kava

N acetyl cysteine

St. John’s wort

Valerian

For more information on the implications of taking herbal medicines just before, during, and after surgery, see Hodges PJ, Kam PC. The peri-operative implications of herbal medicines. Anaesthesia. 2002 Sep;57(9):889-99.

Expert approaches: natural products recommended before surgery

Some drugs and supplements—including nutritional food supplements—might be recommended to help “build you up” before surgery as well as help your tissues heal after surgery. For recommendations of natural products to take before surgery, see these protocols, programs, and plans.

The Definitive Guide to Cancer, 3rd Edition: An Integrative Approach to Prevention, Treatment, and Healing

By Lise Alschuler, ND, FABNO, and Karolyn Gazella

See Chapter 6, Supporting Your Body during Conventional Treatment, the section “Support before and after surgery.”

Life over Cancer: The Block Center Program for Integrative Cancer Care

By Keith Block, MD

See Chapter 22, The Surgical Support Program.

The Breast Cancer Companion: A Complementary Care Manual: Third Edition

By Barbara MacDonald, ND, FABNO

See Chapter 4, Preparing for Surgery, and Appendix 2, Handout on Preparing for Breast Cancer Surgery with Naturopathic Medicine.

Minimizing the stress from surgery

Surgery may be an important, even life-saving, part of your treatment plan. But surgery itself brings trauma to your body—sometimes in ways that can alter your body terrain to support tumor growth. This could be through stress, low body temperature, and blood clots, for instance. Some aspects of surgery may affect your immune response and other body terrain factors, possibly making your terrain temporarily more favorable for cancer growth. Preparing for and minimizing your stress response can have long-term benefits.

Your body’s stress response

Inflammation

Even if you’re feeling calm, incisions and removing tumors, organs, or other tissue creates trauma to your body. The trauma will create an inflammatory response in your body. Out-of-balance inflammation is a terrain factor related to cancer growth.

Immune function

Stress—both physical and emotional/mental—can suppress your immune system, which can impact tumor progression. The use of anesthesia during surgery also stresses your body,20Khanna AK, Riveros Perez E, Laudanski K, Moraska A, Cummings III KC. Perioperative care and cancer recurrence: Is there a connection? World Journal of Anesthesiology. 2014 Mar 27;3(1):31-45. although we are not implying that you should undergo surgery without anesthesia. However, some techniques that can reduce your need for anesthesia may reduce the stress load and its impacts on your immune system. We discuss these in On your surgery day ›  

Surgery is a major source of stress and is linked to immune suppression that “may predispose already immunosuppressed cancer patients to tumor spread.”21Vallejo R, Hord ED, Barna SA, Santiago-Palma J, Ahmed S. Perioperative immunosuppression in cancer patients. Journal of Environmental Pathology, Toxicology and Oncology. 2003;22(2):139-46.The greater your body’s stress level, the greater the suppression of your immune system following surgery. This is likely one reason that surgery has been linked to an increased risk of metastasis.22Horowitz M, Neeman E, Sharon E, Ben-Eliyahu S. Exploiting the critical perioperative period to improve long-term cancer outcomes. Nature Reviews. Clinical Oncology. 2015 Apr;12(4):213-26. 

The physical stress of surgery on your body is similar to the stress brought on by sudden, intense exercise. Like with exercise, you can prepare for surgery similarly to building up your strength and stamina before an intense exercise event. Just like with training for a marathon, Improving your physical fitness prior to surgery can improve your recovery.23Howard R, Yin YS et al. Taking control of your surgery: impact of a prehabilitation program on major abdominal surgery. Journal of the American College of Surgeons. 2019 Jan;228(1):72-80. 

Preparing for cancer treatment: If you prepare yourself mentally and emotionally, you will decrease your stress hormones and body’s stress responses. We offer several suggestions for integrative approaches to prepare yourself for upcoming cancer treatments.

Blood clots 

Blood clots can be life-threatening and may increase your risk of cancer recurrence after surgery.24Hiller JG, Perry NJ et al. Perioperative events influence cancer recurrence risk after surgery. Nature Reviews Clinical Oncology. 2018 Apr;15(4):205-218. Often doctors will give an injection under the skin before or after surgery to prevent blood clots. Your surgical team may also put special boots on your legs during surgery and while you are admitted to the hospital to reduce this risk. These measures are important to keep you safe and improve your cancer outcomes.

Managing anxiety before surgery

Anxiety can take a toll on your body. It releases hormones and chemicals that lower your immune response and uses energy reserves better left for your surgery and healing. 

Anxiety is linked to these outcomes:

  • Lower health-related quality of life, lower cognitive performance and self-perception of worse memory and attention before surgery among people with clinically relevant anxiety, mostly for brain tumors (modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently))
  • More depressive symptoms after surgery among people with clinically relevant anxiety before surgery, mostly for brain tumors (modest evidence)
  • Lower Quality of Recovery Scale scores among people with higher anxiety before and/or after elective abdominal surgery (preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently))

This handbook summarizes therapies and practices that can promote a state of calm and relaxation to reduce anxiety. Practicing or using them regularly may reduce your anxiety.

Resources

Keep reading about integrative approaches to surgery

Authors

Laura Pole, RN, MSN, OCNS

Senior Clinical Consultant
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Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.

For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.

Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.

Laura Pole, RN, MSN, OCNS Senior Clinical Consultant

Nancy Hepp, MS

Lead Researcher and Program Manager
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Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.

Nancy Hepp, MS Lead Researcher and Program Manager

Reviewer

Whitney You, MD, MPH

Research Consultant
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Dr. You is a physician specializing in maternal-fetal medicine (MFM) with a specific interest in cancer in the context of pregnancy. She completed a postdoctoral fellowship in health services research with a focus in health literacy and received a Master of Public Health.

Whitney You, MD, MPH Research Consultant

Last update: August 25, 2022

Last full literature review: September 2021

CancerChoices provides information about integrativein cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.

Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.

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