Objective:

To evaluate the impact of a standardized multimodal prehabilitation program on postoperative outcomes in patients undergoing elective colorectal cancer surgery.

Approach:

• Study Design: Retrospective analysis of 401 patients who underwent elective surgical resection for primary colorectal cancer between January 2022 and April 2024.
• Comparison: Outcomes were compared between a nonstandardized prehabilitation approach and a standardized multimodal prehabilitation program.
• Evaluation Metrics: Participation rates, referral patterns, physiotherapy outcomes, postoperative complications, hospital length of stay, and 90-day mortality were assessed.

Key Findings:

• Participation in prehabilitation increased from 40% to 59% after implementing the standardized program.
• Median postoperative hospital stay decreased from 4 days to 3 days following the standardized program.
• Rates of postoperative complications and 90-day mortality were similar between the two periods, with complications occurring in about one-quarter of patients.
• Documentation of the rationale behind decisions not to refer patients for prehabilitation improved, increasing from 44% to 67%.
• Among patients who participated in physiotherapy, median maximal work capacity on the steep ramp test increased from 160 W to 213 W, and median one-repetition maximum leg press strength increased from 100 kg to 135 kg.

Interpretation:

Limitations:

• The study was retrospective and conducted at a single center.
• Referral decisions were based on surgeon judgment rather than standardized objective criteria, potentially introducing selection bias.
• Findings may not be generalizable to other settings.

Conclusion:

Prospective studies are needed to confirm the findings and further define the role of standardized prehabilitation in routine clinical practice.

Sources:

• Journal of Surgical Oncology