Multicenter cohort study of impact of multimodal prehabilitation on complications after colorectal cancer surgery

Surgical resection is the cornerstone of curative treatment for colorectal cancer (CRC) but can be associated with postoperative morbidity. A cohort study at 18 centers in The Netherlands evaluated the effectiveness of a multimodal prehabilitation program in unselected patients undergoing CRC resection. The 4-week program included high-intensity exercise 3 times per week, nutritional support, psychological counseling, and optimization of comorbidities when indicated. Outcome parameters were complications, length of hospital stay, and rates of readmission and intensive care admission, compared between the prehabilitation group and historical controls from the same centers using propensity score matching (n=1192 patients per group). Overall complications rates were lower in the prehabilitation group (30.1% versus 37.8%; OR 0.71; 95% CI 0.60-0.84), as were medical complications (15.4% versus 24.6%; 0.56; 0.46-0.69) and surgical complications (21.4% versus 24.9%; 0.82; 0.68-1.00); median length of hospital stay was 4 days (IQR 3-6) versus 5 days (4-8; p<0.001), whereas rates of readmission and intensive care admission were reduced. The authors conclude that implementation of a multimodal prehabilitation program for unselected patients undergoing CRC surgery was associated with reduced complication rates and length of hospital stay.