Multimodal Prehabilitation and Major Complications after Colorectal Surgery for Cancer: The impact of Improving Preoperative Functional Capacity.

Background

Multidisciplinary consensus agrees on the necessity to reduce major complications after abdominal surgery, as these represent a significant burden to patients and society. Multimodal prehabilitation programs comprising physical exercise, nutritional and anxiety-coping interventions have been shown to improve perioperative functional capacity in a greater proportion of patients. The impact of this improvement on major complications has not been investigated yet. The purpose of this study is to determine whether a preoperative functional improvement reduces the incidence of major complications after colorectal surgery.

Methods

This study involved a sample of 109 participants enrolled in one pilot and two randomized controlled trials. All participant underwent a 4-week multimodal prehabilitation program before colorectal surgery. Functional capacity was assessed with a six-minute walk test, a validated measure of surgical recovery that measure the distance walked on a flat hard surface in 6 minutes (6MWD). 
As the minimal clinically important difference of 6MWD is estimated at 20 m, two groups were defined as follows: one included participants whose change in 6MWD from baseline was less than 20 m (n=48) and the other included those whose change in 6MWD was at least 20 m (n=61). Complication severity was graded according to the Clavien–Dindo classification, and those graded as III–V were defined as major. Primary outcome was the incidence of major complications. 

Results

There were no significant baseline differences between the groups for age, gender, BMI, ASA, Charlson Comorbidity Index, CR-POSSUM scores, cancer stage, surgical procedure and approach, duration of surgery and intraoperative blood loss. Participants experiencing a significant preoperative functional improvement had a lower baseline 6MWD (406.8 [IQR 377.6- 436.0] m vs. 448.0 [IQR 419.2-477.0] m, p=0.05). There were 6 (13%) major complications among subjects with a change in 6MWD below 20 m, and one (2%) in the other group (p=0.042). 

Conclusion

Preliminary data indicate that patients who achieved a preoperative significantly improvement in functional walking capacity are more likely to have less major complications after colorectal cancer surgery.

Multimodal prehabilitation and major complications after colorectal surgery for cancer: the impact of improving preoperative functional capacity