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Ann Surg Oncol
Ann Surg Oncol
Annals of Surgical Oncology
1068-9265
1534-4681
Springer International Publishing Cham

38990226
15835
10.1245/s10434-024-15835-3
ASO Author Reflections
ASO Author Reflections: Improving Postoperative Outcomes in Colorectal Cancer Surgery: Where are We with Prehabilitation?
http://orcid.org/0000-0002-9715-860X
Steffens Daniel PhD daniel.steffens@health.nsw.gov.au

12
Solomon Michael J. DMed 12
Jack Sandy PhD 3
West Malcolm A. PhD 34
1 https://ror.org/05gpvde20 grid.413249.9 0000 0004 0385 0051 Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW Australia
2 https://ror.org/0384j8v12 grid.1013.3 0000 0004 1936 834X Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
3 grid.430506.4 0000 0004 0465 4079 National Institute for Health and Social Care Research, Southampton Biomedical Research Centre, Perioperative and Critical Care Theme, University Hospitals Southampton, Southampton, UK
4 https://ror.org/01ryk1543 grid.5491.9 0000 0004 1936 9297 Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
11 7 2024
11 7 2024
2024
31 10 64746475
28 6 2024
28 6 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by/4.0/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
University of Sydney Open Access funding enabled and organized by CAUL and its Member Institutions

issue-copyright-statement© Society of Surgical Oncology 2024
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pmcPast

Despite the development of minimally invasive surgical techniques and the implementation of comprehensive Enhanced Recovery After Surgery (ERAS) protocols, colorectal cancer surgery still carries significant postoperative morbidity, which slows recovery and increases healthcare costs.1 Prehabilitation, including exercise, nutrition and psychological interventions, has been proposed to optimize preoperative patient health and reduce postoperative morbidity;2 however, the effectiveness of different prehabilitation modalities in colorectal cancer surgery remains unclear.3 Our systematic review and meta-analysis aimed to synthesize the evidence from the latest randomized controlled trials on the impact of prehabilitation on postoperative complications and length of hospital stay in this population.

Present

Our systematic review identified a total of 23 prehabilitation trials in colorectal cancer patients undergoing surgery.4 We found moderate-quality evidence that preoperative nutrition interventions reduced postoperative infectious complications by 35% and length of hospital stay by approximately 1 day compared with usual care. This highlights nutrition optimization as a promising strategy to improve surgical outcomes. However, the evidence was less certain for multimodal, exercise, and psychological prehabilitation due to the limited number of trials, variation in reported outcomes, and low quality of evidence overall. High-quality research is still needed to determine the optimal prehabilitation approach.

Future

To advance the field of prehabilitation in colorectal cancer surgery, several key steps are necessary. First, establishing a core set of outcomes and developing prehabilitation guidelines will provide a framework for designing high-quality trials that can be meaningfully compared and synthesized. Second, investigating the impact of prehabilitation adherence on outcomes and exploring the potential synergistic benefits of multimodal interventions will help optimize prehabilitation strategies. Identifying patient factors that predict response to prehabilitation will enable personalized interventions to be targeted to those most likely to benefit. Furthermore, developing less resource-intensive prehabilitation programs that can be widely implemented is crucial for maximizing accessibility and cost effectiveness. Ultimately, appropriately powered multicenter trials incorporating these elements are required to provide definitive evidence to support the integration of prehabilitation into standard preoperative care. By reducing postoperative complications and accelerating recovery of daily activities, effective prehabilitation has the potential to significantly improve long-term patient outcomes and quality of life after colorectal cancer surgery.

Funding

Open Access funding enabled and organized by CAUL and its Member Institutions.

Disclosure

Daniel Steffens, Michael J. Solomon, Sandy Jack, and Malcolm A. West have no disclosures to declare that may be relevant to the contents of this article.

This article refers to: Steffens D, Nott F, Koh C, et al. Effectiveness of Prehabilitation Modalities on Postoperative Outcomes Following Colorectal Cancer Surgery: A Systematic Review of Randomised Controlled Trials. Annals Surgical Oncology. Epub 24 2024. https://doi.org/10.1245/s10434-024-15593-2.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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References

1. Brown KGM Solomon MJ Mahon K O’Shannassy S Management of colorectal cancer BMJ 2019 366 l4561 10.1136/bmj.l4561 31439545
Brown KGM, Solomon MJ, Mahon K, O’Shannassy S. Management of colorectal cancer. BMJ. 2019;366:l4561.31439545
2. Durrand J Singh SJ Danjoux G Prehabilitation Clin Med (London, England) 2019 19 458 464 10.7861/clinmed.2019-0257
Durrand J, Singh SJ, Danjoux G. Prehabilitation. Clin Med (London, England). 2019;19:458–64.
3. Steffens D Beckenkamp PR Hancock M Solomon M Young J Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer Br J Sports Med 2018 52 344 10.1136/bjsports-2017-098032 29437041
Steffens D, Beckenkamp PR, Hancock M, Solomon M, Young J. Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer. Br J Sports Med. 2018;52:344.29437041
4. Steffens D Nott F Koh C Effectiveness of prehabilitation modalities on postoperative outcomes following colorectal cancer surgery: a systematic review of randomised controlled trials Ann Surg Oncol 2024 10.1245/s10434-024-15593-2 39284989
Steffens D, Nott F, Koh C, et al. Effectiveness of prehabilitation modalities on postoperative outcomes following colorectal cancer surgery: a systematic review of randomised controlled trials. Ann Surg Oncol. 2024. 10.1245/s10434-024-15593-2.39284989
