Patients undergoing colorectal cancer resections are at risk for delayed recovery. Prehabilitation aims to enhance functional capacity preoperatively for better toleration of surgery and to facilitate recovery. The authors previously demonstrated the limited impact of a prehabilitation program using exercise alone. They propose an expanded trimodal prehabilitation program that adds nutritional counseling, protein supplementation, and anxiety reduction to a moderate exercise program. This study aimed to estimate the impact of this trimodal program on the recovery of functional capacity compared with standard surgical care.
Consecutive patients were enrolled in this pre- and postintervention study over a 23-month period. The postoperative recovery for 42 consecutive patients enrolled in the prehabilitation program was compared with that of 45 patients assessed before the intervention began. The primary outcome was functional walking capacity (6-min walk test [6MWT]). The secondary outcomes included self-reported physical activity (CHAMPS questionnaire) and health-related quality of life (SF-36). Data are expressed as mean ± standard deviation or median (interquartile range [IQR]) and were analyzed using Chi-square and Student’s t test. All p values lower than 0.05 were considered significant.
The prehabilitation and control groups were comparable in terms of age, gender, body mass index (BMI) and American Society of Anesthesiology (ASA) class. There was no difference in walking capacity at the first assessment (6MWT distance, 422 ± 87 vs 402 ± 57 m; p = 0.21). During the prehabilitation period lasting a median of 33 days (range, 21–46 days), functional walking capacity improved by 40 ± 40 m (p < 0.01). The postoperative complication rates and the hospital length of stay were similar. The patients in the prehabilitation program had better postoperative walking capacity at both 4 weeks (mean difference, 51.5 ± 93 m; p = 0.01) and 8 weeks (mean difference, 84.5 ± 83 m; p < 0.01). At 8 weeks, 81 % of the prehabilitated patients were recovered compared with 40 % of the control group (p < 0.01). The prehabilitation group also reported higher levels of physical activity before and after surgery.
In this pilot study, a 1-month trimodal prehabilitation program improved postoperative functional recovery. A randomized trial is ongoing (NCT01356264).
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This research was supported by grants from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), Ethicon Endosurgery Canada, and the Department of Anesthesia, McGill University Health Centre. The Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation is supported by an unrestricted educational grant from Covidien Canada.
C. Li reports research support from the Surgeon Scientist Program, Department of Surgery, McGill University. L. S. Feldman reports research and fellowship support from Covidien and research support from Ethicon. L. Lee reports research support from the Canadian Association of General Surgeons and salary support from the Fonds de la recherche en santé du Québec (FRSQ) and the McGill Surgeon Scientist program. F. Carli, P. Charlebois, B. Stein, A. S. Liberman, P. Kaneva, B. Augustin, M. Wongyingsinn, A. Gamsa, D. J. Kim, and M. C. Vassiliou have no conflicts of interest or financial ties to disclose.
Presented at the SAGES 2012 Annual Meeting, March 7–March 10, 2012, San Diego, CA.
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Li, C., Carli, F., Lee, L. et al. Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: a pilot study. Surg Endosc 27, 1072–1082 (2013). https://doi.org/10.1007/s00464-012-2560-5
- Functional recovery
- Perioperative care
- Preoperative exercise