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Meta-Analysis
. 2022 Sep;148(9):2187-2213.
doi: 10.1007/s00432-022-04088-w. Epub 2022 Jun 13.

Effects and duration of exercise-based prehabilitation in surgical therapy of colon and rectal cancer: a systematic review and meta-analysis

Roberto Falz  1 , Christian Bischoff  2 , René Thieme  3 , Johannes Lässing  2 , Matthias Mehdorn  3 , Sigmar Stelzner  3 , Martin Busse #  2 , Ines Gockel #  3
Affiliations
Meta-Analysis

Effects and duration of exercise-based prehabilitation in surgical therapy of colon and rectal cancer: a systematic review and meta-analysis

Roberto Falz et al. J Cancer Res Clin Oncol. 2022 Sep.

Abstract

Purpose: Functional capacity is an independent indicator of morbidity in colon and rectal cancer surgery. This systematic review describes the evaluated and synthesized effects of exercise prehabilitation depending on the duration of interventions on functional and postoperative outcomes in colon and rectal cancer surgery.

Methods: Three electronic databases (MEDLINE Pubmed, Web of Sciences, and Cochrane Registry) were systematically searched (January 2022) for controlled trials that investigated the effects of prehabilitation prior to colo-rectal cancer resection.

Results: Twenty-three studies were included in this systematic review and 14 in our meta-analyses assessing these outcomes: the 6 min walk distance (6MWD), postoperative overall complications, and length of stay (LOS). We observed a significant improvement in preoperative functional capacity as measured with 6MWD (mean difference: 30.8 m; 95% CI 13.3, 48.3; p = 0.0005) due to prehabilitation. No reductions in LOS (mean difference: - 0.27 days; 95% CI - 0.93, 0.40; p = 0.5) or postoperative overall complications (Odds ratio: 0.84; 95% CI 0.53, 1.31; p = 0.44) were observed. Prehabilitation lasting more than 3 weeks tended to lower overall complications (Odds ratio: 0.66; 95% CI 0.4, 1.1; p = 0.11). However, the prehabilitation time periods differed between colon and rectal carcinoma resections.

Conclusion: Prehabilitation while the patient is preparing to undergo surgery for colorectal carcinoma improves functional capacity; and might reduce postoperative overall complications, but does not shorten the LOS. The studies we reviewed differ in target variables, design, and the intervention's time period. Multicenter studies with sufficient statistical power and differentiating between colon and rectal carcinoma are needed to develop implementation strategies in the health care system.

Registration: PROSPERO CRD42022310532.

Keywords: 6-min walk distance (6MWD); Colorectal carcinoma (CRC); Length of stay (LOS); Morbidity and mortality; Postoperative outcome; Preoperative physical exercise.

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Conflict of interest statement

The authors have no conflicts of interest to report.

Figures

Fig. 1
Fig. 1
PRISMA flow chart of included and excluded studies within this systematic review and meta-analysis (Page et al. 2021)
Fig. 2
Fig. 2
Meta-analysis of change in 6MWT distance with and without prehabilitation
Fig. 3
Fig. 3
Meta-analysis of postoperative complications with and without prehabilitation
Fig. 4
Fig. 4
Meta-analysis of length of hospital (LOS) stay with and without prehabilitation
Fig. 5
Fig. 5
Cochrane risk of bias assessment of randomized controlled trials included in meta-analysis
Fig. 6
Fig. 6
Funnel plots of the meta-analysis: A Postoperative overall complications; B LOS; C 6MWT distance after prehabilitation
See this image and copyright information in PMC

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