Prehabilitation in Colorectal Cancer Surgery: A Narrative Review of Current Evidence and Clinical Perspectives.

Background/

Objectives

Surgical treatment of colorectal cancer (CRC) is associated with a substantial risk of postoperative complications and delayed recovery of functional capacity, particularly in older patients and those with multiple comorbidities. Preoperative prehabilitation has emerged as a strategy aimed at optimizing patients' physical, nutritional, and psychological status prior to surgery; however, its clinical effectiveness and feasibility of implementation remain subjects of ongoing debate. The aim of this narrative review was to provide a clinically oriented synthesis of current evidence regarding multimodal prehabilitation in patients undergoing CRC surgery, with particular emphasis on perioperative outcomes, functional recovery, nutritional optimization, and implementation-related considerations.

Methods

A targeted narrative review of the peer-reviewed literature indexed in PubMed (2015-2025) was conducted to identify contemporary review-type publications, including narrative reviews, systematic reviews, scoping reviews, and meta-analyses, addressing prehabilitation in CRC surgery. The findings were synthesized narratively and interpreted with emphasis on clinical applicability and translational relevance.

Results

Twenty contemporary review publications were included in the analysis. Across the included publications, the most frequently reported favorable effects were observed for multimodal prehabilitation, incorporating physical exercise, nutritional support, and a psychological component. These interventions were associated with improvements in functional capacity and, in some meta-analyses, with a reduction in postoperative complication rates and shorter length of hospital stay, particularly in high-risk patients. Prehabilitation was assessed as safe and well tolerated.

Conclusions

The current body of evidence indicates that multimodal prehabilitation may constitute a beneficial adjunct, particularly in improving functional capacity, while its impact on hard postoperative outcomes remains closely dependent on intervention quality, appropriate patient selection, and seamless integration with established perioperative care pathways. Future meta-analyses should address underexplored components of prehabilitation, including preparation for stoma formation and targeted educational and psychological support related to sexual health.