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Multimodal prehabilitation in colorectal cancer surgery: randomized clinical trial
By Bjerregaard F, Pekkari K, Asklid D and 4 others.
Abstract
Background
Colorectal cancer (CRC) surgery remains associated with substantial postoperative morbidity despite implementation of enhanced recovery after surgery (ERAS). Prehabilitation improves surgical outcomes, but evidence remains inconsistent. This study evaluated whether multidisciplinary prehabilitation reduces postoperative complications and whether treatment effects vary according to baseline physical function.
Methods
This single-centre randomized clinical trial was conducted at a tertiary referral hospital in Stockholm, Sweden (28 October 2021-23 April 2025). Adults with histologically confirmed CRC scheduled for elective resection were randomized 1 : 1 to multidisciplinary prehabilitation (medication review, nutritional counselling, supervised exercise, and targeted risk optimization) or standard care (ERAS). Analyses followed a modified intention-to-treat (mITT) principle. Prehabilitation was initiated within 3 days of enrolment. The primary outcome of interest was postoperative complications (Clavien-Dindo grade ≥ I). Secondary outcomes included severe complications (Comprehensive Complication Index), reoperations, length of hospital stay (LOS), postoperative weight loss, physical performance and function (6-minute walk test, Timed Up and Go test, and 30-second chair stand test), health-related quality of life (EORTC QLQ-C30), mental health (Hospital Anxiety and Depression Scale), and correlation with the Disability Rating Index (DRI) score.