Netherlands: Findings from the PREHAB Trial

Findings from the PREHAB trial revealed the benefit of a multimodal prehabilitation program before colorectal cancer surgery, as indicated by fewer postoperative severe and medical complications and an optimized postoperative recovery versus standard care. The findings were published in JAMA Surgery on March 29, 2023.

"A 4-week multimodal prehabilitation program may be beneficial in patients undergoing resection for nonmetastasized colorectal cancer," the researchers wrote in their study.

Colorectal surgery is linked with a lowered functional capacity and substantial morbidity rates. These unfavourable sequelae may be attenuated by optimizing the patient's condition for weeks before surgery. Therefore, Charlotte Johanna Laura Molenaar, Máxima Medical Center, Veldhoven, the Netherlands, and colleagues aimed to investigate whether multimodal prehabilitation before colorectal cancer surgery can lower postoperative complications and enhance functional recovery in a multicenter, international randomized clinical trial.

Adult patients with nonmetastasized colorectal cancer were evaluated for eligibility and allocated to either prehabilitation or standard care. The trial was conducted at teaching hospitals with implemented enhanced recovery after surgery programs. Patients in both arms were given perioperative care. Patient enrollment was done from June 2017 to December 2020, with follow-up completion in December 2021. However, due to the COVID-19 pandemic, the trial was stopped prematurely.

The 4-week in-hospital supervised multimodal prehabilitation program comprised:

• A high-intensity exercise program three times per week
• Psychological support
• A nutritional intervention
• A smoking cessation program when required

The researchers determined the CCI (Comprehensive Complication Index) score, the number of patients with a CCI score of more than 20, and the improvement in walking capacity shown as the 6-minute walking distance four weeks postoperatively.

Study Findings

• In the intention-to-treat population of 251 people (median age, 69 years; 55% were male, 82% had tumours located in the colon, and 93% underwent laparoscopic- or robotic-assisted surgery).
• The number of severe complications (CCI score >20) was remarkably lower favouring prehabilitation compared with standard care (17.1% versus 29.7%; odds ratio, 0.47).
• Participants in prehabilitation encountered fewer medical complications (e.g., respiratory) than participants receiving standard care (15.4% versus 27.3%; odds ratio, 0.48).
• Four weeks after surgery, the 6-minute walking distance did not differ significantly between groups compared to baseline (mean difference prehabilitation vs standard care 15.6 m).
• Secondary functional capacity parameters in the postoperative period generally favoured prehabilitation compared with standard care.

Our findings showed the benefit of a multimodal prehabilitation program before colorectal cancer surgery as indicated by fewer postoperative medical and severe complications and an optimized postoperative recovery versus standard care.

Reference

Molenaar CJL, Minnella EM, Coca-Martinez M, et al. Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial. JAMA Surg. Published online March 29, 2023. doi:10.1001/jamasurg.2023.0198