Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation

Abstract

BackgroundColorectal cancer (CRC) is the second most prevalent type of cancer in the world. Surgery is the only curative option. However, postoperative complications occur in up to 50% of patients and are associated with higher morbidity and mortality rates, lower health related quality of life (HRQoL) and increased expenditure in health care. The number and severity of complications are closely related to preoperative functional capacity, nutritional state, psychological state, and smoking behavior. Traditional approaches have targeted the postoperative period for rehabilitation and lifestyle changes. However, recent evidence shows that the preoperative period might be the optimal moment for intervention. This study will determine the impact of multimodal prehabilitation on patients’ functional capacity and postoperative complications.Methods/designThis international multicenter, prospective, randomized controlled trial will include 714 patients undergoing colorectal surgery for cancer. Patients will be allocated to the intervention group, which will receive 4 weeks of prehabilitation (group 1, prehab), or the control group, which will receive no prehabilitation (group 2, no prehab). Both groups will receive perioperative care in accordance with the enhanced recovery after surgery (ERAS) guidelines. The primary outcomes for measurement will be functional capacity (as assessed using the six-minute walk test (6MWT)) and postoperative status determined with the Comprehensive Complication Index (CCI). Secondary outcomes will include HRQoL, length of hospital stay (LOS) and a cost-effectiveness analysis.DiscussionMultimodal prehabilitation is expected to enhance patients’ functional capacity and to reduce postoperative complications. It may therefore result in increased survival and improved HRQoL. This is the first international multicenter study investigating multimodal prehabilitation for patients undergoing colorectal surgery for cancer.Trial registrationTrial Registry: NTR5947 – date of registration: 1 August 2016.

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“…Further research should therefore focus not only on further increasing postoperative survival rates in older patients but also on quality of life and improvement of postoperative physical functioning. Prehabilitation programs could play a role in achieving this goal [40,41].…”

Tumour regression after radiotherapy for rectal cancer – Results from the randomised Stockholm III trial

“…[258][259][260] At least, the idea of "prehab" does not seem to have any negative outcomes, and international randomised trials are ongoing. 261 Although promising evolvements have been made, the level of postoperative complications in the SCRCR has remained rather stable for the last two decades. Around 35 % of the patients are registered with some form of complication.…”

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