MULTIMODAL prehabilitation, consisting of exercise, nutritional intervention, and psychological support, may reduce the incidence of severe post-operative complications and enhance functional recovery in patients undergoing elective resection of non-metastasised colorectal cancer, according to novel data.
“Functional capacity is a strong determinant of a favourable outcome after surgery, leading to a compelling rationale to improve physical, nutritional, and mental status before surgery,” stated author Charlotte Johanna Laura Molenaar, Department of Surgery, Máxima Medical Center, the Netherlands. As there are usually a few weeks between diagnosis and surgery, there is sufficient time for multimodal prehabilitation. Previous trials have suggested that this may improve pre-operative condition, as well as surgical outcome; however, these lack sufficient power.
Molenaar and colleagues conducted a trial including 251 adults with non-metastasised colorectal cancer. All participants received standard peri-operative care, and 123 patients also participated in a 4-week in-hospital prehabilitation programme, consisting of nutritional intervention, a high-intensity exercise program three times per week, psychological support, and a smoking cessation program if needed. Outcomes included the comprehensive complication index score (CCI), the proportion of patients with improved walking capacity, and a CCI over 20.
Researchers noted 149 complications in 37.1% of patients at 30 days post-surgery. The rate of severe complications was significantly lower in the prehabilitation group compared to the standard care group (CCI >20: 17.1% versus 29.7%; odds ratio: 0.47; 95% confidence interval: 0.26–0.87). The team also noted fewer medical complications, including respiratory or cardiovascular events, in those receiving prehabilitation. Furthermore, secondary outcomes such as improvement in functional capacity were improved by prehabilitation. Six-minute walking distance 4 weeks post-surgery was similar in both groups.
The team concluded that “a 4-week in-hospital multimodal prehabilitation programme for patients undergoing elective resection of non-metastasised colorectal cancer decreased the number of severe and medical post-operative complications, and resulted in an enhanced functional recovery after surgery.”