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Prehabilitation in rectal surgery: a narrative review

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim

Neoadjuvant chemotherapy (NACRT) can make decompensated patients more vulnerable prior to rectal surgery. Prehabilitation is an intervention which enhances functional capacity to withstand the stress of surgery. The aim of this review was to evaluate the impact of prehabilitation for patients undergoing rectal surgery on physical fitness and clinical outcomes and to establish feasibility of prehabilitation.

Methods

An analysis of the literature was conducted of PubMed, the Cochrane Library, MEDLINE, EMBASE and ScienceDirect. Articles were initially included based on their title and abstracts reviewed. Full-text copies of those selected were obtained for confirmation of inclusion.

Results

Eight studies were included. Heterogenicity was observed in the structure of exercise programmes. Improvements in physical fitness were observed in six studies. One study demonstrated a statistically significant improvement in quality of life. The prehabilitation programmes were shown to be feasible, with high completion rates. No adverse events were reported. There was limited data regarding the impact of prehabilitation on postoperative outcomes.

Conclusion

Current evidence on prehabilitation in rectal surgery has considerable heterogenicity in both structure of programmes and outcome measures. Standardisation is required for future evaluation of the impact on outcomes. A trimodal approach of exercise, nutritional and psychological interventions has been employed in similar programmes, and should be used in rectal surgery. The intervention should be tailored to the patient and environment. This review highlights the benefits, safety and feasibility of prehabilitation and provides a platform for consensus-building for international trials.

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Authors and Affiliations

  1. Department of Surgery, St Vincent’s University Hospital, Dublin 4, Ireland

    E. Hannan, M. E. Kelly, M. R. Fahy & D. C. Winter

Authors
  1. E. Hannan
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  2. M. E. Kelly
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  3. M. R. Fahy
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  4. D. C. Winter
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Corresponding author

Correspondence to E. Hannan.

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The authors declare no competing interests.

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What does this paper add to the literature?

This review demonstrates that the current evidence base on prehabilitation in rectal surgery has considerable heterogenicity in the programmes utilised. It highlights the benefits, safety and feasibility of prehabilitation and provides a platform for consensus-building for international trials. To our knowledge, this is the first review on this topic.

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Hannan, E., Kelly, M.E., Fahy, M.R. et al. Prehabilitation in rectal surgery: a narrative review. Int J Colorectal Dis 37, 293–299 (2022). https://doi.org/10.1007/s00384-021-04092-5

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  • DOI: https://doi.org/10.1007/s00384-021-04092-5

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