A multidomain perioperative intervention improves postoperative recovery and clinical outcomes after abdominoperineal resection for low rectal cancer: A randomized controlled trial.

BACKGROUND

Abdominoperineal resection (APR) for low rectal cancer is associated with substantial morbidity and psychosocial burden. This randomized controlled trial evaluated whether integrating resilience-oriented cognitive behavioral therapy and behavioral sleep regulation into enhanced recovery after surgery (ERAS) improves clinical and oncologic outcomes.

METHODS

In this single-center trial, 192 patients undergoing curative APR were randomized to standard ERAS or ERAS plus a structured multidomain behavioral intervention. The primary endpoint was 2-year disease-free survival (DFS). Key secondary outcomes included recovery metrics, clinically significant complications, inflammatory markers, and patient-reported outcomes.

RESULTS

The intervention group demonstrated faster bowel recovery, shorter hospitalization, fewer Clavien-Dindo grade ≥ II complications, and lower postoperative CRP, IL-6, and TNF-α levels. Two-year DFS and overall survival favored the intervention.

CONCLUSIONS

Integrating resilience- and sleep-based interventions into ERAS was associated with improved recovery, attenuated perioperative inflammation, and superior 2-year DFS after APR.