Prehabilitation Prior to Colorectal Cancer Surgery: Impact and Implementation

Multimodal prehabilitation aims to improve surgical outcomes and preoperative fitness in patients undergoing surgery for colorectal cancer (CRC). This study evaluated implementation of a standardised prehabilitation programme for elective CRC surgery, assess its impact, and identify pitfalls and challenges during implementation.

Retrospective single-centre study, all CRC patients scheduled for resection between January 2022 and April 2024 were included. Since May 2023, standardised multimodal prehabilitation was introduced. Before, patients received physiotherapy and a dietician if indicated, although this was not routinely offered. Patients were divided into a prehabilitation and non-prehabilitation group. Clinical data, prehabilitation details, and physiotherapy results were collected from patient charts.

Among 401 patients, 198 (49%) underwent prehabilitation. Participation increased after standardisation (40% vs. 59%, p < 0.001). Strength and physical fitness improved significantly (leg press 100 vs. 135 kg; steep ramp 160 vs. 213 W; p < 0.001). Patients in the non-standardised programme experienced a significantly longer postoperative hospital stay than those in standardised programme (4 vs. 3 days, p = 0.010). Despite more comorbidities in prehabilitated patients, complication rates were similar between patients without and with prehabilitation (28% vs. 24%, p = 0.45).

Standardised prehabilitation appears beneficial and safe, improving participation, referral justification and outcomes, particularly in high-risk colorectal cancer patients.