Prehabilitation results in ‘significantly lower’ complications after CRC resection
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Key takeaways:
- A 4-week, in-hospital program of exercise, nutritional intervention and psychological support resulted in fewer postoperative complications.
- Prehabilitation also improved functional recovery.
Multimodal prehabilitation reduced the incidence of severe postoperative complications and enhanced functional recovery among patients who underwent elective resection of non-metastasized colorectal cancer, according to data.
“Functional capacity is a strong determinant of a favorable outcome after surgery, leading to a compelling rationale to improve physical, nutritional and mental status before surgery,” Charlotte Johanna Laura Molenaar, MD, of the department of surgery at Máxima Medical Center in the Netherlands, and colleagues wrote in JAMA Surgery. “After the diagnosis of colorectal cancer, time to surgery usually comprises several weeks, a salient time ideally suited for multimodal prehabilitation.
“Trials that have suggested that prehabilitation may lead to clinically meaningful improvements in the patient’s preoperative condition and surgical outcome lack sufficient power and have heterogeneous design.”
To investigate the effect of multimodal prehabilitation on CRC surgery outcomes, Molenaar and colleagues enrolled 251 adults (median age, 69 years; 55% men) with non-metastasized CRC in the PREHAB randomized clinical trial. Patients were assigned to 4-week in-hospital prehabilitation (n = 123), which consisted of a high-intensity exercise program 3 times per week, nutritional intervention, psychological support and a smoking cessation program when needed, or standard care (n = 128). All participants received standard perioperative care.
Studied outcomes included Comprehensive Complication Index (CCI score, the proportion of patients with a CCI score greater than 20 and improved walking capacity.
Researchers noted 82% of patients had tumors in the colon and 93% underwent laparoscopic or robotic-assisted surgery.
At 30 days after surgery, 149 complications were reported in 37.1% of patients. Patients in the prehabilitation group experienced a “significantly lower” rate of severe complications compared with those in the standard care group (CCI > 20: 17.1% vs. 29.7%; OR = 0.47; 95% CI, 0.26-0.87). Further, patients receiving prehabilitation had fewer medical complications, such as cardiovascular or respiratory events (15.4% vs. 27.3%; OR = 0.48; 95% CI, 0.26-0.89).
Secondary outcomes, including improvement in functional capacity, “generally favored” prehabilitation. Researchers reported no significant difference between groups in 6-minute walking distance 4 weeks after surgery (mean difference, 15.6 m; 95% CI, –1.4 to 32.6).
“A 4-week in-hospital multimodal prehabilitation program for patients undergoing elective resection of non-metastasized colorectal cancer decreased the number of severe and medical postoperative complications and resulted in an enhanced functional recovery after surgery,” Molenaar and colleagues concluded.
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