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Randomized Controlled Trial
. 2023 Nov 1;7(6):zrad134.
doi: 10.1093/bjsopen/zrad134.

Preoperative multimodal prehabilitation before elective colorectal cancer surgery in patients with WHO performance status I or II: randomized clinical trial

Rasmus Dahlin Bojesen  1   2 , Susanne Oksbjerg Dalton  3   4 , Søren Thorgaard Skou  5   6 , Lars Bo Jørgensen  5   6   7 , Line Rosell Walker  1 , Jens Ravn Eriksen  2   8 , Camilla Grube  1   2 , Tobias Freyberg Justesen  2 , Christoffer Johansen  4   9 , Gerrit Slooter  10 , Franco Carli  11 , Ismail Gögenur  2
Affiliations
Randomized Controlled Trial

Preoperative multimodal prehabilitation before elective colorectal cancer surgery in patients with WHO performance status I or II: randomized clinical trial

Rasmus Dahlin Bojesen et al. BJS Open. .

Abstract

Background: Multimodal prehabilitation is a promising adjunct to the current surgical treatment pathway for colorectal cancer patients to further improve postoperative outcomes, especially for high-risk patients with low functional capacity. The aim of the present study was to test the effect of prehabilitation on immediate postoperative recovery.

Method: The study was designed as a RCT with two arms (intervention and control). The intervention consisted of 4 weeks of multimodal prehabilitation, with supervised physical training, nutritional support and medical optimization. The control group received standard of care. A total of 40 patients with colorectal cancer (WHO performance status I or II) undergoing elective surgery with curative intent were included. The primary outcome was postoperative recovery within the first 3 postoperative days, measured by Quality of Recovery-15, a validated questionnaire with a scoring range between 0 and 150 and a minimal clinically relevant difference of 8.

Results: In total, 36 patients were analysed with 16 in the intervention group and 20 in the control group. The mean age of the included patients was 79 years. The overall treatment effect associated with the intervention was a 21.9 (95% c.i. 4.5-39.3) higher quality of recovery-15 score during the first 3 postoperative days compared to control, well above the minimal clinically relevant difference.

Conclusion: Four weeks of multimodal prehabilitation prior to elective curative intended colorectal cancer surgery in patients with WHO performance status I or II was associated with a clinically relevant improvement in postoperative recovery.Registration number: NCT04167436 (http://www.clinicaltrials.gov).

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Figures

Fig. 1
Fig. 1
CONSORT diagram describing the inclusion and exclusion process CRC, colorectal cancer
Fig. 2
Fig. 2
Results of analysis of the primary outcome quality of recovery 15 (QoR-15) within the first 3 postoperative days (POD) X-axis: QoR-15 score. Y-axis: postoperative day. Blue line: intervention group. Red line: control group. Transparent blue and red area: 95% c.i. The table below presents the values and the results of a generalized linear mixed model with unstructured covariance, including the overall effect and differences at each postoperative day between the intervention group and the control group
See this image and copyright information in PMC

References

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