Multimodal prehabilitation in colorectal cancer surgery: randomized clinical trial.
6 affiliations
- 1Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
- 2Department of Surgery and Urology, Danderyd Hospital, Stockholm, Sweden.
- 3Department of Surgery, Capio Kirurgkliniken Stockholm AB, Stockholm, Sweden.
- 4Department of Surgery, Ersta Hospital, Stockholm, Sweden.
- 5Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
- 6Department of Pelvic Cancer, Division of Coloproctology, Center for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden.
Abstract
Background
Colorectal cancer (CRC) surgery remains associated with substantial postoperative morbidity despite implementation of enhanced recovery after surgery (ERAS). Prehabilitation improves surgical outcomes, but evidence remains inconsistent. This study evaluated whether multidisciplinary prehabilitation reduces postoperative complications and whether treatment effects vary according to baseline physical function.Methods
This single-centre randomized clinical trial was conducted at a tertiary referral hospital in Stockholm, Sweden (28 October 2021-23 April 2025). Adults with histologically confirmed CRC scheduled for elective resection were randomized 1 : 1 to multidisciplinary prehabilitation (medication review, nutritional counselling, supervised exercise, and targeted risk optimization) or standard care (ERAS). Analyses followed a modified intention-to-treat (mITT) principle. Prehabilitation was initiated within 3 days of enrolment. The primary outcome of interest was postoperative complications (Clavien-Dindo grade ≥ I). Secondary outcomes included severe complications (Comprehensive Complication Index), reoperations, length of hospital stay (LOS), postoperative weight loss, physical performance and function (6-minute walk test, Timed Up and Go test, and 30-second chair stand test), health-related quality of life (EORTC QLQ-C30), mental health (Hospital Anxiety and Depression Scale), and correlation with the Disability Rating Index (DRI) score.Results
Among 328 randomized patients, 242 underwent CRC surgery and were included in the mITT analysis (120 control, 122 intervention). Postoperative complications occurred in 46.2% of patients, with no significant difference between the intervention and control groups (47.5% versus 45.0%, respectively). Severe complications occurred in 19.0% of patients and were numerically less frequent in the intervention group, but the difference was not statistically significant. LOS and reoperation rates were similar. The intervention group had lower postoperative weight loss and modest improvements in physical performance and patient-reported physical function at 30 days. In exploratory analyses, a significant interaction was observed between treatment allocation and baseline DRI score, indicating greater reduction in severe complications among patients with higher levels of preoperative disability (P = 0.011).Conclusions
Multidisciplinary prehabilitation did not reduce postoperative complications after CRC surgery. However, exploratory analyses suggest that patients with greater preoperative disability derive greater benefit, supporting targeted prehabilitation strategies in higher-risk populations. Registration number: NCT04909567 (https://clinicaltrials.gov/).
Related
- Immunonutrition vs. Standard Oral Nutritional Supplements in Prehabilitation for Colorectal Cancer Surgery: A Randomized Clinical Trial Assessing Morbidity and Body Composition by Computed Tomography
- Nationwide Implementation of Multimodal Prehabilitation and Complications After Colorectal Cancer Surgery
- Perioperative Intravenous Antibiotic Regimens and Surgical Site Infection After Colorectal Surgery: Clinical Associations and External Evaluation of Risk Prediction Models
- Prehabilitation and Early Recovery After Surgery (ERAS) in head and neck cancers: a protocol for a prospective, stratified, open-label randomised controlled trial in adults (PreERA)
- Comparison of remimazolam total intravenous anesthesia versus sevoflurane inhalational anesthesia on emergence agitation in patients undergoing laparoscopic surgery for gastric or colorectal cancer: study protocol for a randomized controlled trial
BibTeX
@article{bjerregaard2026multimodal,
title = {{Multimodal prehabilitation in colorectal cancer surgery: randomized clinical trial.}},
author = {Felix Bjerregaard and Klas Pekkari and Daniel Asklid and Claes Anderin and Karin Westberg and Richard Marsk and Ulf O Gustafsson},
journal = {BJS open},
year = {2026},
month = sep,
doi = {10.1093/bjsopen/zrag167},
url = {https://europepmc.org/article/MED/42925093},
note = {CC BY},
}
RIS
TY - JOUR
TI - Multimodal prehabilitation in colorectal cancer surgery: randomized clinical trial.
AU - Felix Bjerregaard
AU - Klas Pekkari
AU - Daniel Asklid
AU - Claes Anderin
AU - Karin Westberg
AU - Richard Marsk
AU - Ulf O Gustafsson
PY - 2026
DA - 2026/09/01
JO - BJS open
DO - 10.1093/bjsopen/zrag167
UR - https://europepmc.org/article/MED/42925093
AB - Background Colorectal cancer (CRC) surgery remains associated with substantial postoperative morbidity despite implementation of enhanced recovery after surgery (ERAS). Prehabilitation improves surgical outcomes, but evidence remains inconsistent. This study evaluated whether multidisciplinary prehabilitation reduces postoperative complications and whether treatment effects vary according to baseline physical function.Methods This single-centre randomized clinical trial was conducted at a tertiary referral hospital in Stockholm, Sweden (28 October 2021-23 April 2025). Adults with histologically confirmed CRC scheduled for elective resection were randomized 1 : 1 to multidisciplinary prehabilitation (medication review, nutritional counselling, supervised exercise, and targeted risk optimization) or standard care (ERAS). Analyses followed a modified intention-to-treat (mITT) principle. Prehabilitation was initiated within 3 days of enrolment. The primary outcome of interest was postoperative complications (Clavien-Dindo grade ≥ I). Secondary outcomes included severe complications (Comprehensive Complication Index), reoperations, length of hospital stay (LOS), postoperative weight loss, physical performance and function (6-minute walk test, Timed Up and Go test, and 30-second chair stand test), health-related quality of life (EORTC QLQ-C30), mental health (Hospital Anxiety and Depression Scale), and correlation with the Disability Rating Index (DRI) score.Results Among 328 randomized patients, 242 underwent CRC surgery and were included in the mITT analysis (120 control, 122 intervention). Postoperative complications occurred in 46.2% of patients, with no significant difference between the intervention and control groups (47.5% versus 45.0%, respectively). Severe complications occurred in 19.0% of patients and were numerically less frequent in the intervention group, but the difference was not statistically significant. LOS and reoperation rates were similar. The intervention group had lower postoperative weight loss and modest improvements in physical performance and patient-reported physical function at 30 days. In exploratory analyses, a significant interaction was observed between treatment allocation and baseline DRI score, indicating greater reduction in severe complications among patients with higher levels of preoperative disability (P = 0.011).Conclusions Multidisciplinary prehabilitation did not reduce postoperative complications after CRC surgery. However, exploratory analyses suggest that patients with greater preoperative disability derive greater benefit, supporting targeted prehabilitation strategies in higher-risk populations. Registration number: NCT04909567 (https://clinicaltrials.gov/).
SN - 2474-9842
ER -