Prehabilitation in rectal surgery: a narrative review

Area of Science:

• Colorectal Surgery
• Neoadjuvant Chemoradiotherapy (NACRT)
• Prehabilitation Interventions

Background:

• Neoadjuvant chemotherapy (NACRT) can compromise patients undergoing rectal surgery.
• Prehabilitation aims to improve functional capacity to mitigate surgical stress.

Purpose of the Study:

• Evaluate prehabilitation's impact on physical fitness and clinical outcomes in rectal surgery patients.
• Assess the feasibility of prehabilitation programs for this population.

Main Methods:

• Systematic literature review of major databases (PubMed, Cochrane, MEDLINE, EMBASE, ScienceDirect).
• Inclusion based on title/abstract screening, followed by full-text review.

Main Results:

• Eight studies were included, showing heterogeneity in exercise program structures.
• Six studies reported improvements in physical fitness; one showed improved quality of life.
• Prehabilitation programs demonstrated feasibility with high completion rates and no adverse events.
• Limited data exists on the impact of prehabilitation on postoperative outcomes.

Conclusions:

• Evidence on prehabilitation in rectal surgery is heterogeneous; standardization is crucial for outcome evaluation.
• A trimodal approach (exercise, nutrition, psychological support) is recommended, tailored to individual patient needs.
• Prehabilitation is beneficial, safe, and feasible, providing a basis for future international trials.