Defining "optimal recovery" in colorectal surgery: a path to precision prehabilitation.

PURPOSE: This study defined "optimal recovery" as a multidimensional composite endpoint for colorectal cancer surgery and investigated whether its predictors were specific to tumor location.

METHODS

In this retrospective cohort of 396 patients undergoing curative-intent resection, optimal recovery required achievement of 5 criteria: no major complications, timely gastrointestinal recovery, ambulation by postoperative day (POD) 2, oral intake by POD 4, and discharge by POD 7. Multivariable logistic regression was used to identify predictors in the overall cohort and site-specific subgroups. The endpoint was then evaluated against 30-day patient-reported outcomes using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30).

RESULTS

The optimal recovery rate was 44.4%. Four independent predictors emerged: age <60 years (odds ratio [OR], 2.35; P<0.001), prognostic nutritional index (PNI) ≥46 (OR, 2.70; P<0.001), operation time ≤180 minutes (OR, 2.94; P<0.001), and blood loss ≤30 mL (OR, 2.17; P=0.005). Subgroup analysis revealed marked divergence between cancer sites: blood loss was the dominant predictor in colon cancer (OR, 6.67; P<0.001), whereas PNI predominated in rectal cancer (OR, 2.56; P=0.005). Patients achieving optimal recovery reported significantly better global health status (72.4 vs. 63.8; P<0.001) and physical functioning (83.5 vs. 74.2; P<0.001) at 30 days.

CONCLUSION

Optimal recovery provides a stringent quality benchmark, with findings highlighting site-specific determinants of recovery. Recovery after colon surgery was associated primarily with technical factors, particularly lower blood loss, whereas recovery after rectal surgery was strongly linked to nutritional status. These results support precision prehabilitation strategies tailored to site-specific pathophysiology. Trial registration: Registered in the Chinese Clinical Trial Registry (No. ChiCTR2300075424) on September 9, 2023.