Effects and duration of exercise-based prehabilitation in surgical therapy of colon and rectal cancer: a systematic review and meta-analysis

Abstract

Purpose Functional capacity is an independent indicator of morbidity in colon and rectal cancer surgery. This systematic review describes the evaluated and synthesized effects of exercise prehabilitation depending on the duration of interventions on functional and postoperative outcomes in colon and rectal cancer surgery. Methods Three electronic databases (MEDLINE Pubmed, Web of Sciences, and Cochrane Registry) were systematically searched (January 2022) for controlled trials that investigated the effects of prehabilitation prior to colo-rectal cancer resection. Results Twenty-three studies were included in this systematic review and 14 in our meta-analyses assessing these outcomes: the 6 min walk distance (6MWD), postoperative overall complications, and length of stay (LOS). We observed a significant improvement in preoperative functional capacity as measured with 6MWD (mean difference: 30.8 m; 95% CI 13.3, 48.3; p = 0.0005) due to prehabilitation. No reductions in LOS (mean difference: – 0.27 days; 95% CI – 0.93, 0.40; p = 0.5) or postoperative overall complications (Odds ratio: 0.84; 95% CI 0.53, 1.31; p = 0.44) were observed. Prehabilitation lasting more than 3 weeks tended to lower overall complications (Odds ratio: 0.66; 95% CI 0.4, 1.1; p = 0.11). However, the prehabilitation time periods differed between colon and rectal carcinoma resections. Conclusion Prehabilitation while the patient is preparing to undergo surgery for colorectal carcinoma improves functional capacity; and might reduce postoperative overall complications, but does not shorten the LOS. The studies we reviewed differ in target variables, design, and the intervention’s time period. Multicenter studies with sufficient statistical power and differentiating between colon and rectal carcinoma are needed to develop implementation strategies in the health care system. Registration PROSPERO CRD42022310532

Prehabilitation for general surgery: a systematic review of randomized controlled trials

“…Acknowledging this regional bias within the literature, this synthesis of the current RCT evidence base suggests that internationally, but particularly in local Australian and New Zealand (as the definition from the Royal Australasian College of Surgeons was used for trial inclusion 18 ) General Surgery and perioperative care systems, prehabilitation interventions should only be implemented in specific patient populations, as there is unlikely to be significant benefit (particularly when considering associated time and resource investment) from additional supplementary protocols implemented across the discipline of General Surgery. 18 Although within the surgical literature even the results of sub-population meta-analyses are mixed, examples of these specific General Surgery populations where particular benefit could be found include hepatobiliary and gastrointestinal cancer surgery, where prehabilitation likely reduces length of postoperative hospital stay, 63 in particular colorectal cancer surgery where functional capacity and complication rates may be improved, 8 and bariatric surgery where body composition, functional capacity, and quality of life may be improved. 64 This systematic review adds to an evidence base that has historically found mixed results.…”

“…64 This systematic review adds to an evidence base that has historically found mixed results. [7][8][9][10][11][12][13][14][15][16][17] Past literature in colorectal cancer surgical populations has found that physical prehabilitation interventions are likely to improve functional capacity and reduce complication rates. 12 For major abdominal surgery the optimal protocol for delivery remains unclear, although if implemented effectively could reduce overall and pulmonary postoperative morbidity.…”

“…However, this incorporates a large degree of heterogeneity in procedures, pathology, therapies, and patient populations. While broad systematic reviews have been conducted synthesizing data across large portions of General Surgery, [7][8][9][10][11][12][13][14][15][16][17] many of these omit notable general surgery procedures (e.g., breast operations) 18 or patient populations. This is particularly relevant to Australia and New Zealand, where the discipline of General Surgery, as defined by the Royal Australasian College of Surgeons, encompasses many of these operations.…”

Körperliche Aktivität und Ernährung in der Prävention und Therapie des Kolorektalen Karzinoms

“…Allerdings korrelieren die bisher eingesetzten Parameter nicht immer mit den postoperativen Ergebnissen. So konnte eine aktuelle Metaanalyse aus 14 Studien eine signifikante Verbesserung im 6MWT aufzeigen; ein Einfluss auf die Parameter "postoperative Komplikationsrate" und "Länge des Krankenhausaufenthaltes" blieb jedoch aus [44]. Zu ähnlichen Ergebnissen kommt auch eine aktuelle Cochrane-Analyse [45].…”

Prähabilitation

“…In einer weiteren aktuell publizierten Metaanalyse wurden 14 randomisierte Studien eingeschlossen, welche Prähabilitationsprogramme bei Patienten mit kolorektalem Karzinom berücksichtigten. Hier konnten signifikante Verbesserungen in der funktionellen Kapazität, gemessen anhand des 6-Minuten-Gehtests, aber keine signifikanten Ergebnisse hinsichtlich der Krankenhausaufenthaltsdauer und der Komplikationsrate gezeigt werden 19 .…”