Identifying Patients with Colorectal Cancer Likely to Benefit from a Trimodal Prehabilitation Prior to Surgery.

Introduction

While enhanced recovery after surgery (ERAS) programs are widely implemented to reduce postoperative complications of colorectal cancer surgery, evidence for trimodal prehabilitation is inconsistent. We compared prehabilitation+ERAS versus ERAS alone, and explored patient subgroups most likely to benefit from targeted prehabilitation.

Methods

A prospective, single-center parallel cohort study was conducted from October 2017 to August 2022. Consecutive adults undergoing elective colorectal surgery received ERAS alone or a 3-6-week trimodal prehabilitation programme (nutritional optimization, aerobic training, psychological preparation), followed by ERAS. Primary outcomes were overall postoperative morbidity at 7 and 30 days. Secondary outcomes included mortality, severe morbidity (Clavien-Dindo ≥ 3), 30-day readmission, and ICU/ward length of stay.

Results

Of 344 screened patients, 244 were analyzed (ERAS n = 104; prehabilitation n = 140) with comparable baseline characteristics. Prehabilitation improved 6 min walk distance and incentive spirometry FVC by the time of surgery (p < 0.001 and p = 0.001, respectively), but between-group differences were not sustained at 8 weeks. Overall 7- and 30-day morbidity and mortality, severe morbidity, 30-day readmission, and length of stay did not differ between cohorts. In exploratory subgroup analyses, myosteatosis was associated with higher 7- and 30-day morbidity in the ERAS cohort (7% vs. 28% and 11.6% vs. 40%, respectively), whereas this contrast was not observed under prehabilitation. Among myosteatotic patients, prehabilitation was associated with lower 7-day morbidity (p = 0.045). Frailty was associated with severe morbidity, irrespective of allocation. Discussion: Trimodal prehabilitation improved preoperative functional measures but did not reduce short-term complications overall. CT-defined myosteatosis may help target prehabilitation to higher-risk patients.