Randomized clinical trial of prehabilitation in colorectal surgery

Carli, Francesco; Charlebois, Patrick; Stein, Barry S.; Feldman, Liane S.; Zavorsky, Gerald S.; Kim, D J; Scott, Susan C.; Mayo, Nancy E.

doi:10.1002/bjs.7102

Cited by 431 publications

(424 citation statements)

References 40 publications

Supporting

Mentioning

385

Contrasting

Unclassified

Order By: Relevance

“…Although some degree of physiologic improvement during the preoperative period was shown by most of the studies, this change did not consistently translate into improved clinical outcomes. One example is a randomized controlled trial (RCT) [16] in 112 patients undergoing colorectal surgery, who received a home-based program, which was either a sham intervention (control group with basic recommendation to walk daily and perform breathing exercises), or a home-based high-intensity training program (consisting of both aerobic and resistance exercise). Patients in the control group performed better than those who engaged in intense exercise of whom a large proportion deteriorated in functional walking capacity (measure of functional exercise capacity) during the presurgical period.…”

Section: Resultsmentioning

confidence: 99%

Promoting a culture of prehabilitation for the surgical cancer patient

2017

View full text Add to dashboard Cite

Background: Traditional rehabilitative approaches to perioperative cancer care have focused on the postoperative period to facilitate the return to presurgical baseline conditions. However, there is some realization that the preoperative period can be a very effective time for intervention as the patients are more amenable to target their physiological condition to prepare to overcome the metabolic cost of the surgical stress. Methods: We undertook a narrative review of the current literature on surgical prehabilitation and discussed the current evidence of preoperative interventions before cancer surgery in order to increase physiological reserve before surgery and accelerate postoperative recovery. Results: Published data indicate the positive impact of prehabilitation on postoperative functional capacity and return to daily activities. However, the current evidence on the impact on short-and long-term clinical outcome is limited, and more research needs to be conducted. Conclusion: Preliminary findings indicate that a group of interventions such as exercise, nutrition and anxiety reduction in the preoperative period can complement the enhanced recovery program and facilitate the return to baseline activities of daily living. It is not clear at this stage whether the preoperative increase in functional capacity mitigates the burden of postoperative morbidities and subsequent cancer therapies. Therefore, more research is warranted.

show abstract

Section: Resultsmentioning

confidence: 99%

Promoting a culture of prehabilitation for the surgical cancer patient

2017

View full text Add to dashboard Cite

show abstract

“…Although our sample size is modest and thus results must be interpreted with caution, the factors identified as associated with complications do indicate the potential for improving patients' preoperative status. The addition of a multimodal prehabilitation program may enhance patients' preoperative performance status, might help them to recover faster and be less dependent on healthcare support during and after treatment [11,12]. As certain patients will undergo neoadjuvant treatment, it might be interesting to prehabilitate during this.…”

Section: Discussionmentioning

confidence: 99%

“…The first and largest randomized controlled trial on surgical prehabilitation compared two exercise regimens (intense exercise on a stationary bike vs. walking and deep breathing) for several weeks before colorectal surgery [11]. The primary outcome was functional walking capacity measured by the six-minute walk test (6MWT) between five and nine weeks postoperatively.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Preoperative modifiable risk factors in colorectal surgery: an observational cohort study identifying the possible value of prehabilitation

et al. 2017

View full text Add to dashboard Cite

Surgery is the most common therapeutic intervention, and associated with 20-40% reduction in physiological and functional capacity. Postoperative complications occur in up to 50% of patients resulting in higher mortality rates and greater hospital costs. The number and severity of complications is closely related to patients' preoperative performance status. The aim of this study was to identify the most important preoperative modifiable risk factors that could be part of a multimodal prehabilitation program. Methods: Prospectively collected data of a consecutive series of Dutch CRC patients undergoing colorectal surgery were analyzed. Modifiable risk factors were correlated to the Comprehensive Complication Index (CCI) and compared within two groups: none or mild complications (CCI <20), and severe complications (CCI 20). Multivariate logistic regression analysis was done to explore the combined effect of individual risk factors. Results: In this 139 patient cohort, smoking, malnutrition, alcohol consumption, neoadjuvant therapy, higher age, and male sex, were seen more frequently in the severe complications group (CCI 20). Patients with severe complications had significantly longer hospital stay (16 vs. 6 days, p < 0.001). The risk for severe complications was increased in patients with ASA score III [adjusted odds ratio (OR) 4.4, 95% CI 1.04-18.6], and hemoglobin level <7 mmol/l (adjusted OR 3.3, 95% CI 1.3-8.2). Compared to having no risk factors, more than one risk factor increased OR of severe complications (crude OR 5.2, 95% CI 1.8-15). Conclusion: This study revealed that the risk of getting severe complications increases with the number of risk factors present preoperatively. Several preoperative patient-related risk factors are modifiable. Multimodal prehabilitation may improve patients' preoperative status and should be tested in a multicenter randomized controlled trial. With an international consortium (Copenhagen, Montreal, Paris, Eindhoven) we initiated a randomized controlled trial (NTR5947).

show abstract

“…We identified 14 randomised controlled trials investigating either physical activity or diet/excess body weight, or both, in patients with colorectal cancer -there were no randomised controlled trials investigating smoking or alcohol consumption [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The interventions consisted mainly of telephone-prompted walking or cycling interventions and were mostly in the adjuvant setting.…”

Section: Feasibilitymentioning

confidence: 99%

Commentary on Lifestyle Interventions Are Feasible in Patients with Colorectal Cancer with Potential Short-Term Health Benefits

Bryce¹,

Moug²

2017

J Comm Pub Health Nurs

View full text Add to dashboard Cite

The problemWith the increasing incidence and heavy disease burden of colorectal cancer, there is a new need to improve the quality and length of survivorship in patients with this illness. The management of colorectal cancer involves multi-disciplinary working through multimodal treatment pathways and in itself has significant effects on the physical and psychological health of patients. Major surgery, adjuvant and neo-adjuvant chemotherapy and radiotherapy, and the possibility of a stoma are included in the list of challenges patients must overcome in their journey through the treatment of this illness.One such strategy to improve the quality and length of survivorship is lifestyle interventions. Modification of lifestyle factors has been shown to play a role in reducing the risk of developing colorectal cancer, including modifications in excess weight, poor diet, smoking, alcohol excess and physical inactivity [1][2][3][4][5][6]. However, given the difficulty in performing randomised controlled trials in lifestyle interventions in colorectal cancer, there is doubt about the feasibility of such interventions [7,8]. With this in mind, we have recently published a systematic review [9] which sought to collate the evidence for the feasibility of performing lifestyle factor interventions in patients with colorectal cancer, allowing conclusions on the short and long-term health benefits to be drawn. FeasibilityWe identified 14 randomised controlled trials investigating either physical activity or diet/excess body weight, or both, in patients with colorectal cancer -there were no randomised controlled trials investigating smoking or alcohol consumption [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25]. The interventions consisted mainly of telephone-prompted walking or cycling interventions and were mostly in the adjuvant setting. Dietary interventions focused on low-fat, high-fibre diets and were mostly part of multi-modal lifestyle interventions. We noted a low drop-out rate among these interventions, suggesting they are feasible. Although the majority were performed in the adjuvant setting, we also noted interventions being performed in the neo-adjuvant setting (including pre-habilitation) and even many years after completion of treatment. Short-term outcomes and crossover benefitsIn addition to a low drop-out rate among these randomised controlled trials we also noted shortterm improvements in both physical health (dietary quality, physical fitness) and quality of life. It should also be mentioned that many of these trials recruited from populations of patients with no one individual cancer, i.e. not specifically colorectal cancer. These findings reinforce the importance of correcting lifestyle factors not solely in colorectal cancer, but in many other cancers. Furthermore, given the well-documented and widely accepted role of lifestyle factors in the development of many other widespread diseases (cardiovascular disease, cerebrovascular disease, diabetes) [26], any lifestyle interventions to improv...

show abstract

Randomized clinical trial of prehabilitation in colorectal surgery

Abstract: There was an unexpected benefit from the recommendation to increase walking and breathing, as designed for the control group. Adherence to recommendations was low. An examination of prehabilitation 'responders' would add valuable information.

Cited by 431 publications

References 40 publications

Promoting a culture of prehabilitation for the surgical cancer patient

Promoting a culture of prehabilitation for the surgical cancer patient

Preoperative modifiable risk factors in colorectal surgery: an observational cohort study identifying the possible value of prehabilitation

Commentary on Lifestyle Interventions Are Feasible in Patients with Colorectal Cancer with Potential Short-Term Health Benefits

Contact Info

Product

Resources

About