The Role of Multimodal Prehabilitation in Improving Postoperative Functional Outcomes in Colorectal Cancer Patients: A Review
DOI:
https://doi.org/10.67380/jfnha.v1i1.45Keywords:
colorectal cancer patients, functional outcomes, multimodal, prerehabilitation, postoperativeAbstract
Colorectal cancer is the third most common type of cancer worldwide and the second leading cause of death. Surgery remains the primary treatment modality, but the resulting surgical stress often triggers significant metabolic, cardiovascular, and psychological responses. Post-surgery, patients are at risk of a 20% to 40% decrease in functional capacity, leading to an increased risk of complications and prolonged hospital stay. This review aims to evaluate the benefits of a multimodal pre-rehabilitation program on improving post-operative functional and clinical outcomes in colorectal cancer patients. The methods of this article were searched through Scopus and PubMed databases for the period 2021-2026. Keywords used in the literature search included "prehabilitation" or "pre-habilitation," "colorectal cancer," and "functional outcome" or "6MWT." The results show that a multimodal pre-rehabilitation program integrating physical exercise, nutritional support, and psychological support (anxiety management and relaxation techniques) yields positive outcomes. The key efficacy parameter, 6MWT, demonstrated a highly significant increase in distance traveled compared to the control group, both pre-operatively (+96 meters) and at the 4- to 8-week post-operative evaluation. Furthermore, this intervention plays a role in reducing the incidence of major complications (Clavien-Dindo grade ≥ III) and has been shown in numerous studies to shorten hospital stays. The conclusion is that multimodal pre-rehabilitation is an effective perioperative preparation approach for colorectal cancer patients. This program consistently improves functional capacity, accelerates post-operative recovery, reduces the risk of serious complications, and shortens hospital stays, making it a standard strategy for improving patients' quality of life.
References
Argilés, G., Tabernero, J., Labianca, R., Hochhauser, D., Salazar, R., Iveson, T., Laurent-Puig, P., Quirke, P., Yoshino, T., Taieb, J., Martinelli, E., & Arnold, D. (2020). Localised colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 31(10), 1291–1305. https://doi.org/10.1016/j.annonc.2020.06.022.
Baas, J., Schotten, M., Plume, A., Côté, G., & Karimi, R. (2020). Scopus as a curated, high-quality bibliometric data source for academic research in quantitative science studies. Quantitative Science Studies, 1(1), 377–386. https://doi.org/10.1162/QSS_A_00019
Boyle, H., Fullbrook, A., Wills, A., Veal, I., Peat, N., Al-Noor, Z., Bradshaw, R., Raga, A., Hegarty, A., Hainsworth, A., Ilyas, M., Banugo, P., & Bidd, H. (2023). Multimodal prehabilitation service for patients with colorectal cancer: the challenges of implementation. BMJ Open Quality, 12(2), Article e002064. https://doi.org/10.1136/bmjoq-2022-002064.
Chang, M. C., Choo, Y. J., & Kim, S. (2023). Effect of prehabilitation on patients with frailty undergoing colorectal cancer surgery: a systematic review and meta-analysis. Annals of Surgical Treatment and Research, 104(6), 313. https://doi.org/10.4174/astr.2023.104.6.313
Gamage, B., Gamage, M. N., Perera, N. M., Kodikara, C. S., Wijeratne, J. U. M., Seneviratne Alles, S. M. D. P., Kumaran, T., Jeewandara, J. M. C., & Mahawithanage, S. T. C. (2024). Impact of mindfulness-based tri-modal prehabilitation on functional recovery and selected surgical outcomes of patients with colorectal cancer admitted to surgical hospital wards: the first international randomised control trial for mindfulness-based tri-modal prehabilitation. BMJ Open, 14(12), Article e080192. https://doi.org/10.1136/bmjopen-2023-080192
Gao, S., Liao, X., He, Y., Tan, Z., Jiang, L., & Yang, J. (2026). The effectiveness of multimodal prehabilitation on functional capacity and clinical outcomes in patients undergoing elective laparoscopic colorectal cancer surgery: a systematic review of meta-analysis of randomized controlled trials. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-026-01978-7
Gillis, C., Fenton, T. R., Gramlich, L., Sajobi, T. T., Culos-Reed, S. N., Bousquet-Dion, G., Elsherbini, N., Fiore JR, J. F., Minnella, E. M., Awasthi, R., Liberman, A. S., Boutros, M., & Carli, F. (2020). Older frail prehabilitated patients who cannot attain a 400 m 6-min walking distance before colorectal surgery suffer more postoperative complications. European Journal of Surgical Oncology. https://doi.org/10.1016/j.ejso.2020.09.041
Gonella, F., Massucco, P., Perotti, S., Gianolio, S., Vassallo, D., Monasterolo, S., Laezza, A., De Zolt Ponte, B., Ricotti, A., & Ferrero, A. (2024). PREHAB, ERAS, REHAB: A PATIENT CARE CONTINUUM AROUND COLO-RECTAL SURGERY. European Journal of Surgical Oncology, 108688. https://doi.org/10.1016/j.ejso.2024.108688
Groen, L. C., van Gestel, T., Daams, F., van den Heuvel, B., Taveirne, A., Bruns, E. R., & Schreurs, H. W. (2023). Community-based prehabilitation in older patients and high-risk patients undergoing colorectal cancer surgery. European Journal of Surgical Oncology, 107293. https://doi.org/10.1016/j.ejso.2023.107293
Liao, Y., Chiu, H., Huang, F., Chang, Y., Huang, Y., Wei, P., Wang, W., Hung, C., & Tung, H. (2025). Prehabilitation Interventions in Patients Undergoing Colorectal Cancer Surgery: A Systematic Review and Meta‐Analysis. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.19425
Mao, J.-X., Gao, R., Wang, Y., Yan, X.-B., & Wang, H.-H. (2025). Surgical treatment of colorectal cancer: A multidimensional review. World Journal of Gastrointestinal Surgery, 17(8). https://doi.org/10.4240/wjgs.v17.i8.107785
Maroto-Izquierdo, S., Bautista, I. J., Pérez-Guerrero, A., Redondo-Delgado, P., Jauregui-Fajardo, I., Simó, V., & Aldecoa, C. (2025). Effects of Prehabilitation Concurrent Exercise on Functional Capacity in Colorectal Cancer Patients: A Systematic Review and Meta-Analysis. Healthcare, 13(10), 1119. https://doi.org/10.3390/healthcare13101119
Molenaar, C. J. L., Minnella, E. M., Coca-Martinez, M., ten Cate, D. W. G., Regis, M., Awasthi, R., Martínez-Palli, G., López-Baamonde, M., Sebio-Garcia, R., Feo, C. V., van Rooijen, S. J., Schreinemakers, J. M. J., Bojesen, R. D., Gögenur, I., van den Heuvel, E. R., Carli, F., Slooter, G. D., Roumen, R. M. H., Janssen, L., . . . Grazzi, G. (2023). Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery. JAMA Surgery. https://doi.org/10.1001/jamasurg.2023.0198
Pesce, A., Fabbri, N., Colombari, S., Uccellatori, L., Grazzi, G., Lordi, R., Anania, G., & Feo, C. V. (2024). A randomized controlled clinical trial on multimodal prehabilitation in colorectal cancer patients to improve functional capacity: preliminary results. Surgical Endoscopy. https://doi.org/10.1007/s00464-024-11198-8
Suárez-Alcázar, M.-P., Folch Ayora, A., Muriach, M., Recacha-Ponce, P., Garcia-Roca, M. E., Coret-Franco, A., Pastor-Mora, J. C., Salas-Medina, P., & Collado-Boira, E. J. (2025). Multimodal Prehabilitation in Colorectal Cancer: Improving Fitness, Lifestyle, and Post-Surgery Outcomes. Healthcare, 13(9), 1083. https://doi.org/10.3390/healthcare13091083.
Tai, R., Yang, F., Wang, J., Wan, S., Xiang, Q., Cheng, Y., Fang, F., & Sun, J. (2026). Evaluating the impact of a modified multi-modal prehabilitation program on perioperative outcomes in Chinese patients undergoing colorectal cancer surgery. Frontiers in Surgery, 13. https://doi.org/10.3389/fsurg.2026.1703293
Triguero-Canovas D, Lopez-Rodriguez-Arias F, Gomez-Martinez M, Sanchez-Guillen L, Peris-Castello F, Alcaide-Quiros M, Morillas-Blasco P, Arroyo A, Ramirez JM. (2023). Home-Based Prehabilitation Improves Physical Conditions Measured By ErgospirometrynAnd 6MWTIn Colorectal Cancer Patients: A Randomized Controlled Pilot Study. Research Square. Doi: https://doi.org/10.21203/rs.3.rs-3152469/v1.
Vu, J., Koh, C., Solomon, M., Brown, K., Karunaratne, S., Cole, R., Smith, P., Raichurkar, P., Denehy, L., Riedel, B., Allen, J., Ancog, K., Angenete, E., Ansari, N., Ausania, F., Beaumont, A., Beilstein, C., Berrevoet, F., Boden, I., . . . Steffens, D. (2024). Patients’ and carers’ views on research priorities in prehabilitation for cancer surgery. Supportive Care in Cancer, 32(6). https://doi.org/10.1007/s00520-024-08585-1
Widmar, M., Keskin, M., Strombom, P., Gennarelli, R. L., Szeglin, B. C., Smith, J. J., Nash, G. M., Weiser, M. R., Paty, P. B., Russell, D., & Garcia-Aguilar, J. (2021). Evaluating the Validity of the Clavien-Dindo Classification in Colectomy Studies. Diseases of the Colon & Rectum, Publish Ahead of Print. https://doi.org/10.1097/dcr.0000000000001966.
Wolf, A. M. D., Hoffman, R. M., Walter, L. C., Zeigler‐Johnson, C., Church, T. R., Guerra, C. E., Elkin, E. B., Etzioni, R., Herzig, A., Oeffinger, K. C., Perkins, R. B., Raoof, S., Tina Shih, Y., Skates, S. J., Kratzer, T. B., Manassaram‐Baptiste, D., & Smith, R. A. (2026). Colorectal cancer screening: An update to the American Cancer Society guideline, 2026. CA: A Cancer Journal for Clinicians, 76(3). https://doi.org/10.3322/caac.70083
Zakhrenko A, Zavgorodniaia MV, Potapchuk AA, Afanasiev AA. (2023). Short-Term Prehabilitation Of Patients With Colorectal Cancer-Protocol Of A Randomized Trial. Kolonoproktologia. 22(2): 70-78. Doi: 10.33878/2023-7556-2023-22-2-70-78.
Zhang, J., Hu, Y., Deng, H., Huang, Z., Huang, J., & Shen, Q. (2024). Effect of Preoperative Lifestyle Management and Prehabilitation on Postoperative Capability of Colorectal Cancer Patients: A Systematic Review and Meta-Analysis. Integrative Cancer Therapies, 23. https://doi.org/10.1177/15347354241235590
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Copyright (c) 2026 Rayhan Shafithri, Zati Hasyyati Ali, Willa Mutia Syafrida (Author)
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