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. 2023 Jun 1;158(6):572-581.
doi: 10.1001/jamasurg.2023.0198.

Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial

Collaborators, Affiliations

Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial

Charlotte Johanna Laura Molenaar et al. JAMA Surg. .

Erratum in

  • Errors in Figure 3.
    [No authors listed] [No authors listed] JAMA Surg. 2023 Jun 1;158(6):675. doi: 10.1001/jamasurg.2023.1553. JAMA Surg. 2023. PMID: 37133848 Free PMC article. No abstract available.

Abstract

Importance: Colorectal surgery is associated with substantial morbidity rates and a lowered functional capacity. Optimization of the patient's condition in the weeks prior to surgery may attenuate these unfavorable sequelae.

Objective: To determine whether multimodal prehabilitation before colorectal cancer surgery can reduce postoperative complications and enhance functional recovery.

Design, setting, and participants: The PREHAB randomized clinical trial was an international, multicenter trial conducted in teaching hospitals with implemented enhanced recovery after surgery programs. Adult patients with nonmetastasized colorectal cancer were assessed for eligibility and randomized to either prehabilitation or standard care. Both arms received standard perioperative care. Patients were enrolled from June 2017 to December 2020, and follow-up was completed in December 2021. However, this trial was prematurely stopped due to the COVID-19 pandemic.

Interventions: The 4-week in-hospital supervised multimodal prehabilitation program consisted of a high-intensity exercise program 3 times per week, a nutritional intervention, psychological support, and a smoking cessation program when needed.

Main outcomes and measures: Comprehensive Complication Index (CCI) score, number of patients with CCI score more than 20, and improved walking capacity expressed as the 6-minute walking distance 4 weeks postoperatively.

Results: In the intention-to-treat population of 251 participants (median [IQR] age, 69 [60-76] years; 138 [55%] male), 206 (82%) had tumors located in the colon and 234 (93%) underwent laparoscopic- or robotic-assisted surgery. The number of severe complications (CCI score >20) was significantly lower favoring prehabilitation compared with standard care (21 of 123 [17.1%] vs 38 of 128 [29.7%]; odds ratio, 0.47 [95% CI, 0.26-0.87]; P = .02). Participants in prehabilitation encountered fewer medical complications (eg, respiratory) compared with participants receiving standard care (19 of 123 [15.4%] vs 35 of 128 [27.3%]; odds ratio, 0.48 [95% CI, 0.26-0.89]; P = .02). Four weeks after surgery, 6-minute walking distance did not differ significantly between groups when compared with baseline (mean difference prehabilitation vs standard care 15.6 m [95% CI, -1.4 to 32.6]; P = .07). Secondary parameters of functional capacity in the postoperative period generally favored prehabilitation compared with standard care.

Conclusions and relevance: This PREHAB trial demonstrates the benefit of a multimodal prehabilitation program before colorectal cancer surgery as reflected by fewer severe and medical complications postoperatively and an optimized postoperative recovery compared with standard care.

Trial registration: trialregister.nl Identifier: NTR5947.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Minnella reported personal fees from Dompé Farmaceutici as employee from June 2021. Dr Gögenur reported grants from Pharmacosmos, surgical grants for travelling and speakers fees from Intuitive, and served on the advisory board for Ethicon outside the submitted work. Dr Slooter reported grants from KWF-Kankerbestrijding, Dutch Cancer Society, and Johnson & Johnson and nonfinancial support from FrieslandCampina and Philips during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Flow Diagram
APR indicates abdominoperineal resection; ASA, American Society of Anesthesiologists.
Figure 2.
Figure 2.. Complications Within 30 Days After Surgery
Complications in the intention-to-treat population (n = 251) are reported as percentage of patients having at least 1 complication, a severe complication (Comprehensive Complication Index score >20), at least 1 medical or surgical complication, and having at least 1 medical and 1 surgical complication. aP <.05.
Figure 3.
Figure 3.. Secondary Outcomes
Secondary outcomes for intention-to-treat population (n = 251) are reported. Median change from baseline is reported. aP <.05 for annotated time point.

Comment in

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