Lung cancer is the leading cause of cancer-related deaths. Patients with stage I-III non-small cell lung cancer (NSCLC) are candidates for surgical resection; however, patients with low muscle mass, myosteatosis, malnutrition or reduced functional capacity preoperatively have a higher risk of postoperative morbidity. Prehabilitation is a care process aiming to enhance functional capacity before surgery to improve surgical outcomes. Study objectives are to test the effect of prehabilitation interventions of a mixed-nutrient supplement (NUT) alone or its combination with exercise (MM, multimodal prehabilitation), compared with placebo-control (CTL), in NSCLC patients on change in functional capacity pre-surgery and post-discharge, muscle mass and myosteatosis, postoperative health-related quality of life (HRQoL), complications and length of hospital stay. We hypothesise that a multi-nutrient supplement, with or without exercise, will be of benefit.

Randomised controlled trial of three parallel arms: 168 patients with operable NSCLC at nutritional risk are randomised 1:1:1 to CTL, NUT or MM. Patients in the NUT and MM groups receive a nutritional supplement consisting of whey protein, leucine, vitamin D and fish oil 4-6 weeks preoperatively and 6 weeks post-discharge. The exercise programme (MM) consists of daily moderate-intensity aerobic activity and resistance training 3 days/week. The following is assessed at baseline, preoperatively and week six post-discharge: functional capacity using the 6 min walk test, muscle mass and myosteatosis using D3-creatine dilution and peripheral quantitative CT, and HRQoL using the Functional Assessment of Cancer Therapy-Lung. Intention-to-treat analysis of covariance will compare between-group differences adjusted for baseline variables. Postoperative functional recovery will be tested by logistic regression. Between-group differences in clinical outcomes will be tested, applying Bonferroni correction.

This trial is approved by the McGill University Health Centre Research Ethics Board (2022-7782). Results will be published in open-access peer-reviewed journals and conference presentations.

NCT05955248.

Abdominal cancer surgery leads to loss of functional capacity. The objective was to evaluate the effects of mobilization within 24 h applied to patients with abdominal neoplasms undergoing major surgery.

A randomized controlled clinical trial was carried out in the Intensive Care Unit. The intervention group performed mobility activities guided by the ICU mobility scale (IMS) in the first 24 h after surgery and the control group performed conventional physiotherapy. Dynamometry was evaluated in the preoperative, 1st POD and postoperative period, as well as the Timed up and go test (TUG).

Patients in the intervention group had greater initial mobility (IMS Scale intervention group: 6.67 ± 0.69; IMS Scale control group: 2.23 ± 0.52; p = 0.001). There was greater level of mobility until discharge from the ICU in patients in the intervention group compared to the control group (IMS at discharge from the ICU in the intervention group: 8.53 ± 0.33; IMS at discharge from the ICU in the control group: 3 ± 0.64). Both groups showed worsening in the TUG test, but it was significant only in the control group.

Early mobilization in patients with abdominal neoplasms undergoing major surgery proved to be effective in maintaining mobility and functional markers.

Objectives: This study aimed to analyze the effect of a multimodal prehabilitation program for colorectal cancer patients in body composition, physical and cardiorespiratory fitness as well as its ability to reduce postoperative complications. Methods: A longitudinal observational study evaluated the efficacy of a prehabilitation intervention based on four components: (a) health education and self-care, (b) nutritional counseling, (c) psychological support, and (d) supervised physical exercise. Body composition was determined through bioelectrical impedance analysis; physical fitness variables such as strength was measured by a handgrip dynamometer for upper limbs, and a squat-jump test, countermovement jump test using a contact platform, and a chair-stand test for lower limbs. Flexibility was assessed with the sit-and-reach test. Cardiorespiratory fitness was assessed with the 6 min walking test (6MWT). Moreover, we measured lifestyles related to the amount of physical exercise by accelerometry. Results: The final cohort included 30 patients. Patients completed an average of 9.90 ± 5.26 exercise sessions. Statistically significant changes with varying effect sizes were observed in the following outcomes: SJ values in cm and W for both sexes (p = 0.021/d = 0.14 and p = 0.043/d = 0.10, respectively), SJ in W for women (p = 0.023/d = 0.21), all chair-stand test values (p = 0.021/d = 0.65 for men, p = 0.004/d = 2.08 for women, and p = 0.000/d = 0.84 for both sexes), and sit-and-reach for both sexes (p = 0.005/d = 0.12) and for men (p = 0.044/d = 0.08). All 6MWT values had statistically significant changes (p = 0.001/0.46). Women reduced the weekly minutes spent in sedentary behavior (p = 0.037/d = 0.65) and increased the minutes spent performing light physical activity (p = 0.037/d = 0.63). With regard to surgical outcomes, there was a tendency towards a decrease in postoperative complications and hospitalization days, as well as minutes in postoperative REA (p = 0.009/d = 0.69) in relation to the control group. Conclusions: Participation in a multimodal prehabilitation program improves several aspects of physical condition and lifestyles related to the amount of physical exercise and reduces both days of hospitalization and several complications post-surgery.

Sarcopenia is thought to be a marker for underlying frailty and malnutrition, contributing to poor functional status and suboptimal healing postoperatively. We aimed to complete an updated systematic review and meta-analysis evaluating the impact of sarcopenia on short- and long-term outcomes following colorectal cancer surgery. We searched MEDLINE, Embase, and CENTRAL up to September 2023. Studies that compared sarcopenic and non-sarcopenic patients' short- and long-term outcomes following curative intent elective surgery for colorectal cancer were included. The main outcomes included postoperative morbidity, postoperative mortality, and length of stay (LOS), among others. Inverse variance random effects meta-analyses was performed. Risk of bias was assessed with Cochrane tools. Certainty of evidence was assessed with GRADE. After screening 215 studies, we included 40 non-randomized studies, totalling 13,422 patients, of which 5,432 (40.4%) were classified as sarcopenic. Across 27 studies, patients with sarcopenia were more likely to experience 30-day postoperative morbidity (40% vs 33%, RR 1.30, 95% CI 1.12-1.50, P < 0.01, I2 79%). The mean LOS was 1.46 days longer for sarcopenic patients (26 studies, 95% CI 0.85-2.07, P < 0.01, I2 82%). Upon pooling data from 13 studies, sarcopenic patients had increased risk of 30-day postoperative mortality (2.8% vs 1.0%, RR 2.74, 95% CI 1.63-4.62, P < 0.01, I2 0%). The findings from this systematic review suggest with low to very-low certainty evidence that in patients who are undergoing curative intent surgery for colorectal cancer, preoperative sarcopenia is associated with poor postoperative outcomes.

Supervised multimodal prehabilitation prior to colorectal cancer (CRC) surgery is associated with reduced complications and enhanced recovery. However, it is labor intensive and expensive. In an aging population with increasing demand and costs on healthcare and staff shortages, home-based prehabilitation (HBP) with an app could be of interest. This study assessed the effectiveness of a Fit4Surgery app in CRC surgery.

The app was effectuated in a prospective cohort study of 100 CRC patients ≥60 years from October 2021-December 2022. The primary outcome was preservation or improvement of the 6-minute walking test (6MWT) six weeks postoperative, compared to baseline. Secondary outcomes were 90-day complication and mortality rate, 90-day readmission, length of stay, 6MWT and Short Performance Physical Battery (SPPB) at different timepoints and total costs.

Three patients needed urgent surgery, remaining 97 patients (mean age 72) using the app for at least three weeks. The 6MWT was preserved in 74.7 % with a 12.1 m higher mean six weeks postoperative, compared to baseline (p = 0.194). A significant higher 6MWT was observed after prehabilitation and one year postoperative, compared to baseline (p=<0.001). The SPPB was significant higher at all timepoints. Overall 90-day complication rate was 25.8 %, readmission rate 6.3 % and mortality occurred in 2.1 %. Total costs were €518.50 per patient.

This is the first study of multimodal HBP by an app for CRC surgery patients with high compliance. Results show promising results regarding functional capacity and a low occurrence of complications, in line with multimodal supervised prehabilitation. This by reducing costs by half.

Multimodal prehabilitation has been widely used in patients undergoing surgery for colorectal cancer and has improved clinical outcomes. The aim of this scoping review is to review the content and current state of clinical practice of multimodal prehabilitation programs.

A systematic literature review of multimodal prehabilitation studies in patients undergoing colorectal cancer surgery was conducted according to the PRISMA extension framework for scoping reviews. The literature was searched via the PubMed, Web of Science, SCOPUS, EMBASE and Cochrane Library databases. The results of the study included the components of multimodal prehabilitation (exercise, nutritional, and psychological interventions) and related evaluation indicators, duration, and compliance-related components.

This review included 12 studies with 9 randomized controlled trials, 1 pilot intervention study, 1 cohort study, and 1 mock-target trial design. Specific protocols for multimodal rehabilitation training vary widely, ranging in duration from 2-8 weeks, and were implemented in healthcare facilities, the community, and at home. Adherence rates ranged from 50% to almost 100%. Common outcome indicators include the 6-minute walk test, comorbidities, length of hospitalization, health-related quality of life, and several anxiety assessment scales.

Current evidence suggests that multimodal preconditioning has a positive effect on the clinical prognosis of patients undergoing elective colorectal cancer surgery. However, owing to the heterogeneity of multimodal rehabilitation in terms of implementation protocols and evaluation metrics, many high-quality studies are still needed to explore the optimal model of multimodal rehabilitation and promote its standardization.

Prehabilitation aims to enhance preoperative functional capacity through exercise, nutrition, and psychological programs. Home-based prehabilitation represents an alternative to hospital prehabilitation, with the advantage of not utilising hospital resources. This review aims to evaluate adherence and clinical effectiveness of home-based prehabilitation.

We searched PubMed, Cochrane, and Embase up to October 1, 2024 for randomised controlled trials comparing home-based prehabilitation with standard care. The primary outcome was the proportion of patients with postoperative complications. Secondary outcomes included protocol adherence, and 6-min walking test. We used risk ratios (RR) and mean differences to summarise the results. The risk of bias was assessed using RoB 2 tool.

We included 29 randomised trials for a total of 3508 patients. Median adherence to home-based prehabilitation programs was 82%. Home-based prehabilitation reduced the proportion of patients with postoperative complications (508/1322 [38.4%] vs 578/1335 [43.3%], risk ratio 0.84, 95% confidence interval [CI] 0.72-0.98, P=0.02, I2=44%, low certainty). After home-based prehabilitation, 6-min walking test performance was better compared with control (MD 28.2 m (95% CI 9.5-46.9; P<0.01, I2=48). Preoperative depression (MD -0.65, 95% CI -0.87 to -0.43; P<0.001, I2=0%), postoperative anxiety (MD -0.50, 95% CI -0.75 to -0.25; P<0.001, I2=0%, low certainty) and length of hospital stays (MD -0.32 days, 95% CI -0.61 to -0.03; P=0.03, I2=45%, low certainty) were lower with home-based prehabilitation.

Home-based prehabilitation reduced the proportion of patients with postoperative complications, but with low certainty of evidence. It also improved preoperative functional capacity, reduced hospital stays, depression and anxiety scores, with good adherence to the intervention.

PROSPERO (CRD42024591208).

Current prehabilitation programs are often limited by poor recruitment and attrition rates. Remote delivery of prehabilitation may reduce barriers to participation and maximize program retention. We aimed to assess the feasibility (uptake, retention, fidelity), preliminary effectiveness, and acceptability of delivering a technology-supported prehabilitation program remotely to oncologic surgical candidates.

This was a one-arm pragmatic feasibility study aiming to follow patients for 4-6 weeks preoperatively and 8 weeks postoperatively. All patients received a home-based aerobic and resistance exercise program, with psychosocial counselling as needed. Those at risk of malnutrition received nutritional counselling and supplements to meet personalized energy and protein targets. Adherence was assessed using an exercise watch and a mobile application for dietary assessment. In addition, we assessed physical effects, with change in 6-min walking distance of 20m defined as clinically meaningful recovery, and post-operative complications. Acceptability was assessed using a convergence mixed-methods approach.

A total of 28 participants were included (median 69, IQR 9.5 years; 12/28, 43 % males). Rate of recruitment was 47 %, retention was 78 %, and attendance was 86-93 %. Participants walked an average of 8168 (SD: 4685) steps per day preoperatively and 6809 (SD: 4819) steps per day postoperatively. They consumed on average 21.6 kcal/kg of ideal body weight (IBW) and 1.1 g protein/kg IBW during the first week of the intervention. Participants demonstrated significant improvements in remote physical tests before surgery (arm strength: +9.7 [5.7, 13.6] repetitions in arm curl, p < 0.001; leg strength: +3.2 [1.4, 4.9] sit-to-stand repetitions in 30 s, p = 0.001; endurance: +19.4 [12.7, 26.1] repetitions in the 2-min step test, p < 0.001). The majority (16/22, 73 %) achieved clinically meaningful recovery at 8 weeks postoperatively. All participants attested to the acceptability of exercising with remote supervision.

A technology-assisted prehabilitation program delivered remotely is feasible and could lead to physical benefits for a surgical cancer population.

Prehabilitation before spinal surgery may enhance patients' ability to withstand physical and mental stress during the perioperative period. It has the potential to reduce complications, accelerate recovery, and deliver sustainable, patient-relevant improvements. However, high-quality evidence remains limited, and it is unclear which prehabilitation concepts, training protocols, and outcomes are most effective for different patient groups.

To evaluate the current state of research on preoperative interventions before spinal surgery, including the representation of subgroups, types of surgical procedures, and prehabilitation concepts. Additionally, it examines the outcomes analyzed and the methodologies employed in existing studies.

Scoping review based on a systematic literature search.

A comprehensive database search in MEDLINE/PubMed, EMBASE (Ovid), CINAHL (EBSCO), Cochrane Library, Physiotherapy Evidence Database, Web of Science and Scopus was conducted. Exercise- and/or education-based prehabilitation concepts were identified, and findings were clustered and summarized according to PRISMA reporting standards.

Thirty-six reports from 23 studies (50% RCTs), evaluating prehabilitation programs in terms of feasibility, experiences, and effects on physical performance, self-reported function, pain, psychological outcomes and health-economic factors were included. These studies encompassed 2,964 participants scheduled for spinal surgery and reported a wide range of preoperative interventions, settings, and adherence rates. Prehabilitation focused primarily on education (87%) and exercise (35%), either independently or in combination. Most authors have concluded that preoperative interventions benefit patients awaiting spinal surgery, particularly by improving self-reported function, disability, and pain in both the short and long term. However, the findings also highlight the variability in outcomes, strengths, limitations, and recommendations across studies. Notably, 76% of the authors advocated for preoperative preparation, emphasizing the importance of structured, personalized programs and the need for further large-scale clinical trials.

Based on the current evidence, preparation for spinal surgery is recommended, provided that it is individualized, multimodal, and interdisciplinary, and addresses patients' specific impairments, resources, and expectations. Future research should focus on identifying subgroups defined by biopsychosocial risk factors that may influence short- and long-term perioperative outcomes.

This pilot study aimed to assess the feasibility and preliminary effects of a supervised, home-based exercise program in patients recovering from laparoscopic colorectal cancer surgery. A total of 23 patients were included, with 13 participating in the exercise intervention and 10 receiving standard postoperative care. The exercise group (intervention group) followed a two-month structured program, while the control group received no structured exercise. Feasibility was demonstrated by 98% adherence in the intervention group and no reported adverse events. At T1, the intervention group showed significant improvements in role function, cognitive function, and reduced fatigue compared to the control group. At T2, a significant difference was observed in physical function. Functional capacity, assessed by the Six-Minute Walk Test, was significantly better in the intervention group at T1, T2, and T3, as was physical performance measured by the Short Physical Performance Battery (SPPB) at T1, T2, and T3. No significant differences were observed between the groups in anxiety, depression, sleep quality, or body composition parameters. This study highlights the feasibility of a supervised home-based exercise program in the early postoperative phase, demonstrating positive effects on Quality of Life, functional recovery, and fatigue in colorectal cancer patients.

Advances in medical care have made cancer rehabilitation an essential component of comprehensive cancer treatment. However, bibliometric analyses in this field remain limited. This study maps the global research landscape of cancer rehabilitation over the past decade.

Relevant publications on cancer rehabilitation from 2013 to 2023 were retrieved from the Web of Science Core Collection (WoSCC) database. Bibliometric analysis was conducted using VOSviewer, CiteSpace, and the R package "Bibliometrics."

A total of 6743 publications from 98 countries demonstrated sustained growth, peaking in 2022. The USA (1581 publications) and China (974) led in research output, while the Netherlands recorded the highest citation impact (32.75 citations per paper). Key institutions included the University of Texas MD Anderson Cancer Center (148 publications) and Memorial Sloan Kettering Cancer Center (40.58 citations per paper). Supportive Care in Cancer ranked as the most influential journal. Research efforts primarily focused on exercise interventions (n = 404), quality of life (n = 688), and breast cancer rehabilitation (n = 440). Recent trends highlighted telemedicine, digital health, and breast cancer-related lymphedema.

This analysis highlights the dominance of high-income countries in cancer rehabilitation research and identifies exercise, quality of life, and breast cancer as enduring focal points. Emerging priorities include technology-driven interventions and lymphedema management. However, critical gaps remain, such as the underrepresentation of low-resource regions, limited focus on pediatric populations, and insufficient integration of advanced technologies (e.g., AI, wearables). Future efforts should emphasize equitable resource distribution, evidence-based pediatric rehabilitation models, and scalable technology-driven solutions to address global disparities and improve survivorship care.

Surgical resection is the primary treatment modality for colorectal cancer. Prehabilitation is about enhancing the patient's physiological capacity preoperatively to reduce the risk of treatment-related complications. Clear definitions of the modality, content, and duration of prehabilitation, including its components such as nutrition, exercise, and psychological support, are lacking. Some review articles have proposed that a multimodal approach may yield the best overall outcomes, but the clinical efficacy of such an approach requires further exploration.

This study consisted of a systematic review and meta-analysis to investigate the effectiveness of multimodal prehabilitation programs for patients undergoing colorectal surgery.

We searched PubMed, Embase, CINAHL, and the Cochrane Library from inception to August 5, 2023, without language or publication period restrictions. The included studies were randomized controlled trials, prospective studies, or retrospective studies that examined the effectiveness of multimodal prehabilitation programs for patients undergoing colorectal surgery. A random-effects model was used for data analysis.

This study included 14 articles that analyzed data from 2314 patients who underwent colorectal cancer surgery. In comparisons against a control group, multimodal prehabilitation significantly reduced the length of hospital stay ([mean difference; MD] = -2.47 days, 95% confidence interval [CI] [-3.56, -1.39]), postoperative complication rate (odds ratio; [OR] = 0.74, 95% CI [0.59, 0.94]), and time to the first passage of flatus (MD = -0.43 days, 95% CI [-0.66, -0.20]).

Multimodal prehabilitation interventions before colorectal cancer surgery reduce hospital stay lengths, lower complication rates, and promote bowel recovery, particularly in older populations.

Prehabilitation is an emerging clinical practice that aims to improve the surgical recovery and quality of life of patients undergoing intensive treatments. This review intends to describe the state of the art in prehabilitation, highlighting the role of nutritional strategies and the current trends in supplements.

Up-to-date studies have shown the importance of optimizing the nutritional status of patients to cope with the physical and metabolic demands of surgery and intensive treatments. In the context of nutritional prehabilitation, oral nutritional supplementation has emerged as a preferred strategy. The effectiveness of prehabilitation has been demonstrated in various clinical contexts. However, the lack of standardized protocols makes it hard to compare the outcomes. Despite the variability in this type of nutritional intervention found in reports, it has been shown that the most common oral nutritional supplements (ONS) contain dairy proteins. The use of whey proteins represents a promising approach from both a nutritional and a sustainability perspective.

The concept of prehabilitation, defined as interventions aimed at enhancing a patient's functional capacity prior to an impending physiological stressor, may contribute to reduced postoperative morbidity and mortality. The study's goal is to verify or refute the feasibility of a prehabilitation programme for two diagnostic patient groups during neoadjuvant chemo(radio)therapy, which is prescribed before the scheduled surgical procedure. This is a single group study design, with all patients enrolled receiving the intervention.

This is an interventional feasibility study of a prehabilitation programme in the form of physical training conducted at home. The training consists of progressively dosed walking and strength exercises for selected muscle groups. Data will be monitored telemetrically and also through telephone contact with participants. Primary outcomes include: the percentage of patients interested in participating in the study out of all patients indicated for neoadjuvant therapy at University Hospital Ostrava during the observed period, the percentage of patients who complete the prehabilitation programme until the date of surgery and individual patient compliance. Secondary outcomes include physical fitness parameters obtained from cardiopulmonary exercise testing, grip strength measured by a dynamometer, changes in body composition, EORTC QLQ-C30 quality of life questionnaire, and a questionnaire on the subjective perception of the exercise programme. Both primary and secondary outcomes will be compared between study arms (two diagnostic groups). The study is registered at ClinicalTrials.gov, ID: NCT05646043.

The results of this study can serve as a foundation for larger, multicentre, controlled studies in the future.

The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition was established to develop ERAS guidelines tailored to the Korean context. This guideline focuses on creating the most current evidence-based practice guidelines for ERAS purposes, based on systematic reviews. All key questions targeted randomized controlled trials exclusively, and if fewer than 2 were available, studies employing propensity score matching were also included. Recommendations for each key question were marked with strength of recommendation and level of evidence following internal and external review processes by the committee.

Prehabilitation aims to improve physiological reserve and psychological resilience, enabling patients to better tolerate the physiological stress of major surgery, thereby reducing the risk of complications and improving surgical outcomes. In this review, we provide an update of the development of prehabilitation in patients having cancer surgery.

We searched databases of peer-reviewed research to identify appropriate papers. Keywords comprised 'prehabilitation', 'cancer surgery' and associated synonyms (prehab; pre-operative rehabilitation; cancer). The results were combined with articles identified by reviewing the references of key papers and the use of the grey literature to develop our discussion.

We detail the different elements of prehabilitation (exercise, nutrition, psychological support) relevant to patients with cancer undergoing surgery, focusing on the recent evidence base and ongoing challenges. Within this, we consider the role of behaviour change in enabling patients to undertake prehabilitation interventions and reflect on the different models of prehabilitation that have been utilised. Facilitators and barriers to implementation of prehabilitation are explored. Key findings include positioning prehabilitation as an integral part of the oncological surgical pathway which includes, but is discrete from, medical optimisation.

Prehabilitation has the potential to improve surgical outcomes for patients undergoing cancer surgery. Further evidence is needed to understand how and what we provide to patients as optimal exercise, nutrition and psychological interventions as part of their surgical care, and how we improve long-term lifestyle using behaviour change methodology. Digital technology offers the opportunity for scaling and greater personalisation of prehabilitation but needs to be deliberately fashioned to ensure equitable access.

Patients requiring upper gastrointestinal surgery for benign oesophageal conditions are at nutrition risk before and after surgery. There is a dearth of published evidence guiding clinicians on effective collaboration with patients to mitigate perioperative nutritional challenges. We conducted a qualitative study aiming to explore patients' perioperative food, nutrition, and educational experiences to guide future care.

Adult patients who had undergone elective, benign oesophageal surgery were invited to participate in semi-structured interviews within 3 weeks of hospital discharge. Interviews were transcribed and analysed with a reflexive form of inductive thematic analysis in addition to synthesised member checking.

Interviews with 12 patients identified three major themes. First, nutrition education fosters a better surgical recovery experience: patients expressed a desire to be prepared for their upcoming surgery and engage in the recovery process with informed food choices. Most patients preferred preoperative education given limited capacity for learning during hospital admission. Second, patients have priorities for nutrition information: patients expressed that educational material should be printed, comprehensive, practical, include familiar foods and focus on managing postoperative physical symptoms. Third, food impacts social and emotional experiences of surgery: resumption of a normal diet was a sign of recovery that enabled social reintegration. Identified themes resonated with Knowles' six-core principles of andragogy.

Patients with benign oesophageal conditions perceived nutrition education to be a vital aspect of surgical preparation and recovery. Re-designing perioperative education with patient input has the potential to improve outcomes and experiences.

With a rapidly aging population and increasing global surgical volumes, managing the elevated risk of perioperative pulmonary complications has become an expanding focus for quality improvement in health care. In this narrative review, we will analyze the evidence-based literature to provide high-quality and actionable management strategies to better detect, stratify risk, optimize, and manage perioperative pulmonary complications in geriatric populations.

Prehabilitation has been increasingly utilized to optimize perioperative outcomes. In this study, we aim to evaluate the impact of uni- and multimodal prehabilitation on functional capacity and postoperative outcomes among surgical oncology patients undergoing major abdominal surgery.

Three electronic databases (PubMed, Embase, Cochrane) were systematically searched up until December 2023. We included randomized controlled trials comparing prehabilitation to standard of care in surgical oncology patients undergoing major abdominal surgery. Our primary outcome was functional capacity as measured by the 6-min walk distance (6MWD). Secondary outcomes include postoperative complications, emergency readmissions, and length of stay (LOS). We stratified our findings to determine the impact of uni- versus multimodal prehabilitation on outcomes.

We included 27 studies with 2532 surgical oncology patients. Overall, patients undergoing prehabilitation demonstrated a significant improvement in preoperative functional capacity compared to those without prehabilitation (mean difference in 6MWD 28.32 meters [m], 95% CI 15.26, 41.39, p < 0.01). Prehabilitation was also associated with significantly lower odds of postoperative complications (odds ratio [OR] 0.60, 95% CI 0.46, 0.78, p < 0.01). There was no difference in emergency readmission (OR 0.90, 95% CI 0.59, 1.38, p = 0.61) or LOS (mean difference -0.42 days, 95% CI -1.01, 0.16, p = 0.15). Comparing uni- versus multimodal prehabilitation, multimodal prehabilitation was associated with greater improvements in functional capacity (6MWD 37.35 m versus 13.38 m) and lower odds of postoperative complications (OR 0.61, 95% CI 0.45, 0.82, p < 0.01 versus OR 0.63, 95% CI 0.36, 1.11, p = 0.10) CONCLUSION: Prehabilitation improves functional capacity and reduces postoperative complications among surgical oncology patients undergoing major abdominal surgery.

Multimodal prehabilitation is a multi-disciplinary program that includes exercise, nutrition, and psychological intervention before surgery to improve pre-operative functional capacity. This study aims to assess the impact of a prehabilitation program on the pre-operative functional status of gynecologic oncology patients.

This single-center, prospective observational study included all consecutive patients diagnosed with gynecologic cancer who were scheduled for surgery and enrolled in a structured prehabilitation program from January 2018 to May 2024. Only patients with both baseline and pre-operative evaluations were included. Functional status data were compared before (baseline) and after (pre-operative) the prehabilitation intervention. The primary outcome measured was functional capacity, as determined by the 6-minute walk test (6MWT). Secondary outcomes included hand grip strength, the Malnutrition Universal Screening Tool (MUST) score, and the Hospital Anxiety and Depression Scale score. The type of training and adherence were also evaluated.

A total of 77 patients underwent both baseline and pre-operative evaluation at the prehabilitation unit. The median duration of the program was 25.2 days (range; 9-63). Significant pre-operative improvements were observed in 6MWT (baseline: 435.7 m, standard deviation [SD] = 115.9 vs pre-operative: 455.7 m, SD = 118.9, p < .001), hand grip strength (baseline: 19.0 kg, SD = 5.5 vs pre-operative: 20.4 kg, SD = 5.9, p = .012), MUST score (baseline MUST ≥2 in 14.3% patients vs pre-operative 3.9%, p = .03), and Hospital Anxiety and Depression Scale score (baseline anxiety score: 7.4, SD = 4.3 vs pre-operative: 6.3, SD = 3.6, p < .001; and baseline depression score: 5.5, SD = 4.2 vs pre-operative: 4.3, SD = 3.6, p < .001). Among the different training programs, patients participating in supervised CrossFit training showed greater improvement in the 6MWT (33.4 m), compared to the hospital-supervised group (27.1 m), and the non-supervised home training group (14.0 m).

A structured multimodal prehabilitation program improves pre-operative functional capacity in gynecologic oncology patients, with the greatest improvements seen in those who participated in supervised high-intensity training, such as CrossFit.

The aim of this work was to evaluate whether the therapeutic quality of exercise prehabilitation programmes is associated with their effectiveness to preoperatively improve aerobic fitness and reduce postoperative complications and length of hospital stay in patients scheduled for colorectal surgery.

Three electronic databases (PubMed, Embase and CINAHL) were systematically searched (up to October 2023) for randomized controlled trials that investigated the effects of prehabilitation before colorectal resection. Methodological quality and therapeutic quality were assessed using, respectively, the Cochrane Risk of Bias 2 tool and the i-CONTENT tool. Studies were divided into four subgroups based on the estimated risk of bias and risk of ineffectiveness.

Fourteen studies were included, comprising 986 patients. Meta-analysis showed that, in general, prehabilitation improved preoperative aerobic fitness but did not improve postoperative outcomes. No differences were found between the four subgroups; however, only one study (7%) had a low risk of bias in combination with a low risk of ineffectiveness.

The fact that only one study had a low risk of bias in combination with a low risk of ineffectiveness precluded us from establishing an association between therapeutic quality and the effectiveness of prehabilitation on postoperative outcomes. The quality of future prehabilitation research with exercise interventions should be improved by using an assessment tool during the design phase of prehabilitation programmes.

Prehabilitation is a crucial component of tumor rehabilitation that attempts to improve patients' preoperative health, although its efficacy in treating patients with cancers of the digestive system is still up for debate.

The records from PubMed (MEDLINE), Embase, Web of Science, Cochrane Library, EBSCO, Scopus, CNKI and Wan fang database up to November 2024 were systematically searched. The Cochrane Collaboration tool was employed for evaluating the risk of bias in each study, and the PRISMA 2020 checklist provided by the EQUATOR network was utilized.

Through quality analysis, 20 articles were included, involving 1719 patients. Although its effect on severe complications is still unknown, the prehabilitation significantly decreased overall postoperative complications when compared to standard care, with a risk ratio (RR) of 0.74 (95% CI: 0.65 to 0.84). Despite not shortening the postoperative hospital stay (MD: -0.13, 95% CI: -0.29 to 0.03), prehabilitation demonstrated notable improvements in the 6-minute walk distance (6MWD), with preoperative gains (MD: 25.87, 95% CI: 14.49 to 37.25) and sustained benefits at 4 weeks postoperatively (MD: 22.48, 95% CI: 7.85 to 37.12). However, no significant differences in 6MWD were observed at 6 or 8 weeks postoperatively. The average improvement in 6MWD from baseline to preoperative was 28.99 (95% CI: 10.89 to 47.08, P = 0.002), and from 4 weeks postoperative to baseline, it was 25.95 (95% CI: 6.84 to 45.07, P = 0.008), with no significant change at 8 weeks. The acceptance and completion rates of prehabilitation were commendably high at 61% (95% CI: 47-75%) and 90% (95% CI: 87-93%), respectively, alongside a relatively low dropout rate of 10% (95% CI: 7% to13%).

Prehabilitation reduces postoperative complications and improves short-term physical function in digestive surgery patients, with good patient acceptance; however, the long-term effects are unknown due to a lack of follow-up data.

It was registered with the International Prospective Register of Systematic Reviews (PROSPERO) with the identification code CRD42022361100.

Patients with endometrial neoplasia (EN) often have multiple comorbidities and a higher surgical risk. Prehabilitation programs (PPs) combine various interventions to improve preoperative conditions and reduce impairment due to surgical stress. We conducted a pragmatic pilot study to evaluate the acceptability and feasibility of a trimodal telehealth PP (exercise, nutrition, and psychological support) for EN patients. The participants could select their exercise group: (1) a supervised PP (SPP), group sessions 3×/week; (2) a semi-supervised PP (SSPP), group session 1×/week, training alone 2×/week; or (3) a physical activity counseling session (PACS). Out of the 150 EN patients awaiting surgery screened during the 18 months of the study recruitment, 66% (99/150) were eligible, and 40% consented to participate (SPP, n = 13; SSPP, n = 17; PACS, n = 9). The overall dropout was low (13%; 5/39), with no significant differences across groups. No serious adverse events occurred. We observed a positive impact on different outcomes across the different groups, such as in the Functional Assessment of Cancer Therapy quality of life score (SPP; delta = 6.1 [CI: 0.9; 12.6]) and functional capacity measured using the 30″ sit-to-stand test (PACS delta = 2.4 [CI: 1.2; 3.6]). The same-day hospital leave was high in the SSPP group (54.5%). Our pilot telehealth PP seems to be safe, feasible, and well accepted and may procure clinical and patient-centered gains that need to be confirmed in a larger trial.

In recent years, the rise in average lifespan has been linked to an increase in the occurrence of diseases associated with aging worldwide. Rectal tumors often occur in elderly patients.

Between January and August 2024, 6 experts in colorectal cancer met to develop an algorithm to organize the interdisciplinary and multimodal preoperative approaches in the octogenarian population with rectal cancer. To develop the algorithm, we conducted a straightforward search within the PubMed database and also reviewed the citations of the most pertinent articles we discovered. The quality of the methods used in the final selection of 76 sources was evaluated, every single source was scrutinized and analyzed, and a team of six experts created an algorithm.

An algorithm for preoperative management of octogenarian patients with rectal cancer was created to encapsulate essential information and provide a contemporary resource for physicians, surgeons, physiotherapists, and nutritionists to utilize in optimal clinical practice.

Octogenarian patients with rectal cancer are special-character groups and require specific preoperative management to better the surgical outcome.

The growing demand for surgical resection in elderly patients with hepatocellular carcinoma highlights the need to understand the impact of preoperative frailty on surgical outcomes. The aim of this multicentre cohort study was to investigate the association between frailty and short- and long-term outcomes after hepatic resection among elderly patients with hepatocellular carcinoma.

A multicentre analysis was conducted on elderly patients with hepatocellular carcinoma (aged greater than or equal to 70 years) who underwent curative-intent resection at ten Chinese hospitals from 2012 to 2021. Frailty was assessed using the Clinical Frailty Scale (with frailty defined as a Clinical Frailty Scale score greater than or equal to 5). The primary outcomes were overall survival and recurrence-free survival; secondary outcomes encompassed postoperative 30-day morbidity and mortality, and 90-day mortality. The outcomes between patients with and without preoperative frailty were compared.

Of the 488 elderly patients, 148 (30.3%) were considered frail. Frail patients experienced significantly higher 30-day morbidity (68.9% (102 of 148) versus 43.2% (147 of 340)), 30-day mortality (4.1% (6 of 148) versus 0.6% (2 of 340)), and 90-day mortality (6.1% (9 of 148) versus 0.9% (3 of 340)) compared with non-frail patients (all P < 0.010). During a median follow-up of 37.7 (interquartile range 20.4-57.8) months, frail patients demonstrated significantly worse median overall survival (41.6 (95% c.i. 32.0 to 51.2) versus 69.7 (95% c.i. 55.6 to 83.8) months) and recurrence-free survival (27.6 (95% c.i. 23.1 to 32.1) versus 42.7 (95% c.i. 34.6 to 50.8) months) compared with non-frail patients (both P < 0.010). Multivariable Cox regression analysis revealed frailty as an independent risk factor for decreased overall survival (HR 1.61; P = 0.001) and decreased recurrence-free survival (HR 1.32; P = 0.028).

Frailty is significantly associated with adverse short-term and long-term outcomes after resection in elderly patients with hepatocellular carcinoma. The findings suggest that frailty assessment should be incorporated into perioperative and postoperative evaluation for elderly patients undergoing hepatocellular carcinoma resection.

Interest in prehabilitation, the preoperative enhancement of patients' condition, is rising in the surgical field. Challenging factors appear to be patients' motivation to participate in and their compliance with prehabilitation programs. The aim of this qualitative study was to study the real-life experience of prehabilitation by assessing the lived experience and perceptions of participants in a multimodal prehabilitation program and to explore factors that influence participation and compliance during prehabilitation.

Patients who underwent surgery for colorectal cancer and who had participated in the 4-week multimodal prehabilitation program "BEFORE" feasibility study were recruited. Their lived experiences were collected through semi-structured, individual, in-depth interviews. Interviews were transcribed verbatim and analyzed using a thematical approach. As no new information emerged after the interviews, data were considered saturated.

Six patients were interviewed. Seven main themes were discussed during the interviews, including information provision, motivation for participation, and content of the program. The results of this study emphasize the importance of adequate patient education, in-hospital exercise with the supervision of physiotherapists, and a patient-centered program. Logistical problems and the impact of cancer diagnosis were most frequently reported as barriers to participation.

Participation could be improved by providing adequate information and solving logistical issues. Patient-centeredness of the program is an important feature in improving adherence.

Home-based exercise training may improve access to surgical prehabilitation in colorectal cancer (CRC) patients, but its efficacy remains unclear. This study systematically investigated the effects of home-based exercise prehabilitation on postoperative exercise capacity, complications, length of hospital stay, and health-related quality of life (HRQoL) in CRC patients.

Randomized controlled trials (RCTs) comparing home-based exercise prehabilitation with control in CRC patients were eligible. We searched MEDLINE, Scopus, Web of Science, PEDro, and SPORTDiscus from their inception to June 3, 2024. Methodological quality was assessed using the PEDro scale, and certainty of evidence was assessed using GRADE. Data were synthesized using random-effects meta-analyses, with sensitivity analysis on studies with good methodological quality (PEDro score ≥ 6).

Eight RCTs involving 1092 participants were included. The primary analysis showed a significant improvement in postoperative 6-min walk distance following home-based exercise prehabilitation compared to control (mean difference (MD) = 30.62: 95% CI: [2.94; 57.79]; low-certainty evidence). However, sensitivity analysis revealed no significant between-group differences (MD = 22.60: 95% CI: [- 6.27; 51.46]). No significant effects of home-based exercise prehabilitation were found on postoperative complications (risk ratio = 1.00: 95% CI: [- 0.78; 1.29]; moderate-certainty evidence), length of hospital stay (MD = - 0.20: 95% CI: [- 0.65; 0.23]; moderate-certainty evidence), and HRQoL (physical functioning: MD = 2.62: 95% CI: [- 6.16; 11.39]; mental functioning: MD = 1.35: 95% CI: [- 6.95; 9.65]; low and very-low certainty evidence).

Home-based exercise prehabilitation does not reduce postoperative complications and length of hospital stay after CRC surgery. Its effects on postoperative exercise capacity and HRQoL remain uncertain due to low-quality evidence.

There is limited evidence depicting ways that behavioral theory and techniques have been incorporated into cancer rehabilitation interventions. Examining their use within cancer rehabilitation interventions may provide insight into the active ingredients that can maximize patient engagement and intervention effectiveness.

This secondary analysis aimed to describe the use of behavior change theory and behavior change techniques (BCTs) in two previously conducted systematic reviews of cancer rehabilitation interventions.

Secondary analysis of randomized controlled trials (RCTs) drawn from two systematic reviews examining the effect of cancer rehabilitation interventions on function and disability.

In-person and remotely delivered rehabilitation interventions.

Adult cancer survivors.

Data extraction included: behavior change theory use, functional outcome data, and BCTs using the Behavior Change Technique Taxonomy (BCTTv1). Based on their effects on function, interventions were categorized as "very", "quite" or "non-promising". To assess the relative effectiveness of coded BCTs, a BCT promise ratio was calculated (the ratio of promising to non-promising interventions that included the BCT).

Of 180 eligible RCTs, 25 (14%) reported using a behavior change theory. Fifty-four (58%) of the 93 BCTs were used in least one intervention (range 0-29). Interventions reporting theory use utilized more BCTs (median=7) compared to those with no theory (median=3.5; U=2827.00, P=0.001). The number of BCTs did not differ between the very, quite, and non-promising intervention groups (H(2)=0.24, P=0.85). 20 BCTs were considered promising (promise ratio >2) with goal setting, graded tasks, and social support (unspecified) having the highest promise ratios.

While there was a wide range of BCTs utilized, they were rarely based on theoretically-proposed pathways and the number of BCTs reported was not related to intervention effectiveness.

Clinicians should consider basing new interventions upon a relevant behavior change theory. Intentionally incorporating the BCTs of goal setting, graded tasks, and social support may improve intervention efficacy.

Major colorectal surgery is associated with 20 to 40% reduction in physiological and functional capacity and higher level of fatigue 6 to 8 weeks after surgery. The primary aim of this study was to analyse the effects of a multimodal prehabilitation program in colorectal cancer patients to improve functional capacity. The secondary outcome was to evaluate postoperative complications and length of postoperative hospital stay as well as to determine the costs of implementation and indirect costs.

A single centre, single-blind, randomized controlled trial was conducted. Patients of age > 18 years undergoing elective colorectal resection for colonic cancer were eligible. Exclusion criteria were metastatic disease, severe walking impairments, renal failure stage > 2, ASA score > 3, preoperative chemo-radiation therapy. Patients have been randomized either to prehabilitation intervention groups, receiving 4-week trimodal prehabilitation (physical exercise and nutritional and psychological support) or to control receiving no prehabilitation. Both groups followed enhanced recovery programs and received rehabilitation accordingly. The primary outcome for functional capacity was measured by the 6-Minute Walking Test (6MWT) 4 and 8 weeks after surgery; to evaluate post-operative complications the Clavien-Dindo classification was used.

An interim analysis of 71 patients undergoing colorectal surgery was performed, with 35 assigned to interventional arm and 36 to control arm. Baseline characteristics were comparable in both groups. The prehabilitation group showed a significant increase in mean 6MWT distance pre-operatively compared to the control group, with an increase of 96 m (523 ± 24.6 vs. 427 ± 25.3, p = 0.01). At 4 and 8 weeks, the prehabilitation group maintained significant improvements, with an increase of 103 m (514 ± 89 vs. 411 ± 115, p = 0.003) and 90 m (531 ± 82 vs. 441 ± 107, p = 0.008), respectively. There were no statistical significant differences in post-operative complications and hospital length of stay between the two groups.

The preliminary results of this study indicate that it is feasible to implement a prehabilitation protocol lasting approximately 4 weeks. This protocol appears to yield a significant improvement in the physical performance of patients with colon cancer undergoing elective colorectal resection at 4 and 8 weeks after surgery.

Neoadjuvant immunotherapy has gone from an idea to an indication in locally advanced lung cancer. Several phase III trials have demonstrated the superiority of neoadjuvant chemoimmunotherapy compared with chemotherapy in this setting. Although such progress has revolutionized the treatment of locally advanced disease, the unmet needs of stage I and stage II patients without lymph node disease have largely been underrepresented in existing trials. Up-front resection with few patients going on to complete adjuvant therapy remains the norm for most stage I and II patients. Emerging evidence now supports the exploration of supplemental checkpoint blockade in well-selected early-stage, node-negative patients with large tumors and no actionable driver mutations. Although concerns surrounding safety and risk exist, patient selection could be substantially improved using novel biomarker approaches that leverage our understanding of the tumor immune microenvironment of lung cancer. This review provides a comprehensive overview of the opportunities and controversies of perioperative immunotherapy in node-negative lung cancer.

Current evidence synthesis of prehabilitation studies in colorectal surgery is based on results of randomized controlled trials (RCT). Although RCTs are the gold standard for effectiveness research, observational studies probably better reflect real-life practice. The aims of the current study were to compare observational studies to RCTs regarding the association between prehabilitation and postoperative outcomes, and characteristics of included patients and interventions.

A systematic search was conducted in PubMed, Embase, and CINAHL (until September 2023). Observational studies and RCTs investigating prehabilitation before colorectal surgery and reporting postoperative complications and/or length of stay (LoS) were included. Two reviewers independently assessed the risk of bias using the Cochrane Risk of Bias 2 tool for RCTs and the Cochrane ROBINS-I tool for observational studies. Meta(regression)-analyses were performed for postoperative complications and LoS.

Pooled results showed a statistically significant reduction in postoperative complications (OR 0.54; 95 % confidence interval (CI) 0.40 to 0.72) and LoS (mean difference (MD) -1.34 CI -2.57 to -0.12) after prehabilitation in observational studies but not in RCTs (complications OR 0.95; CI 0.53 to 1.72; LoS MD 0.16 CI -0.52 to 0.83). Patients included in observational studies were older and more often had an ASA score ≥3. In a meta-regression analysis, these characteristics were not statistically significantly associated with the main outcomes.

Observational studies in a real-life setting showed that prehabilitation can reduce postoperative complications and LoS. To further explore the real-life effectiveness of prehabilitation, specific observational study designs, like a target emulation trial could be used.

Surgical patient optimization is a proactive approach to improve postoperative outcomes. This article reviews the development of the Surgical Patient Optimization Collaborative, an initiative supporting preoperative optimization in British Columbia, Canada.

The Collaborative facilitated optimization programs over two cohorts between 2019 and 2024. A "Change Package" offered screening, intervention, and measurement tools for the following 13 surgical risk factors: anemia, anxiety, body mass index (cohort 2 only), cardiac status, frailty, glycemic control, nutrition, sleep apnea, pain management, physical activity, smoking, social support, substance use, and venous thromboembolism (cohort 1 only). Monthly data submissions from participating sites included the number of patients undergoing optimization, National Surgical Quality Improvement Program-defined 30-day outcomes, length of stay, and patient-reported measures. Run charts were used to analyze the progress of optimization implementation across both cohorts.

Fourteen sites participated in each cohort. In total, 9,686 patients were screened for optimization, with 7,100/7,505 (95%) patients receiving at least one optimization intervention. Improvement shifts in the number of patients screened were identified in the run charts across both cohorts. Most patients felt that their optimization improved their surgical experience and outcomes. Data for clinical outcomes were inconsistently reported from sites and precluded analyses. Barriers to implementation included project complexity and structural characteristics, and facilitators were knowledge and beliefs about the intervention, reflection, and evaluation.

Preoperative optimization programs were successfully implemented across multiple sites in British Columbia. High-quality clinical outcome analyses are still needed to determine the impact of preoperative optimization on postoperative outcomes. The insight gained from the Collaborative's implementation process may help inform future multicentre preoperative optimization efforts.

Prehabilitation aims to improve patients' physical condition before a stressful event, such as surgery, and enhance recovery. Despite its potential benefits, many emerging prehabilitation programs face challenges in enrolling or retaining patients. In our prehabilitation study PHOCUS, which aims to prepare ovarian cancer patients for surgery, we have also encountered lower acceptance and retention rates. Particularly the most vulnerable patients, who are old and frail, and may benefit the most from the prehabilitation, decline participation due to the complexity of the proposed program. In our review we discussed obstacles and barriers that prevent patients' participation based on both literature and our experience. Among the main reasons are patient's low motivation, high intensity of the program and a lack of social support. To overcome these challenges, we suggest increasing the program's flexibility, adapting the program according to individual patient's needs and enhancing patients' education about the benefits of prehabilitation.

Home-based, virtually-supported care models may represent the most efficient and scalable approach to delivering prehabilitation services. However, virtual approaches to prehabilitation are understudied. This manuscript describes the protocol for an internal pilot randomised controlled trial of a virtually-delivered, multimodal prehabilitation intervention.

We will conduct a pragmatic, individual patient, internal pilot randomised controlled trial of home-based, virtually supported, multimodal prehabilitation compared with standard perioperative care in adults undergoing elective, inpatient thoracic, abdominal, pelvic and vascular surgery at five Canadian hospitals. Participants will be partially blinded; clinicians and outcome assessors will be fully blinded. The intervention consists of 3-12 weeks of a home-based, multimodal (exercise, nutrition and psychosocial support) prehabilitation programme supported through an online platform. The primary feasibility outcomes and their progression targets are (1) monthly recruitment of>6 participants at each centre, (2) intervention adherence of>75%, (3) retention of>90% of participants at the patient-reported primary outcome point of 30-days after surgery and (4) elicitation of patient, clinician and researcher-identified barriers to our pragmatic trial. A sample size of 144 participants will be adequate to estimate recruitment, adherence and retention rates with acceptable precision. All participants will be followed to either death or up to 1 year. As an internal pilot, if no substantive changes to the trial or intervention design are required, pilot participant outcome data will migrate, unanalysed by allocation, to the future full-scale trial.

Ethical approval has been granted by Clinical Trials Ontario (Project ID: 4479) and our ethics review board (Protocol Approval #20230399-01T). Results will be disseminated through presentations at scientific conferences, peer-reviewed publications, partner organisations and engagement of social and traditional media.

ClinicalTrials.gov identifier NCT06042491. Protocol, V.1.2, dated 6 June 2024.

Postoperative morbidity in patients undergoing curative colorectal cancer surgery is high. Prehabilitation has been suggested to reduce postoperative morbidity, however its effectiveness is still lacking.

The aim of this study was to investigate the effectiveness of prehabilitation in reducing postoperative morbidity and length of hospital stay in patients undergoing colorectal cancer surgery.

A comprehensive electronic search was conducted in the CINAHL, Cochrane Library, Medline, PsychINFO, AMED, and Embase databases from inception to April 2023. Randomised controlled trials testing the effectiveness of prehabilitation, including exercise, nutrition, and/or psychological interventions, compared with usual care in patients undergoing colorectal cancer surgery were included. Two independent review authors extracted relevant information and assessed the risk of bias. Random-effect meta-analyses were used to pool outcomes, and the quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines.

A total of 23 trials were identified (N = 2475 patients), including multimodal (3 trials), exercise (3 trials), nutrition (16 trials), and psychological (1 trial) prehabilitation. There was moderate-quality evidence that preoperative nutrition significantly reduced postoperative infectious complications (relative risk 0.65, 95% confidence interval [CI] 0.45-0.94) and low-quality evidence on reducing the length of hospital stay (mean difference 0.87, 95% CI 0.17-1.58) compared with control. A single trial demonstrated an effect of multimodal prehabilitation on postoperative complication.

Nutrition prehabilitation was effective in reducing infectious complications and length of hospital stay. Whether other multimodal, exercise, and psychological prehabilitation modalities improve postoperative outcomes after colorectal cancer surgery is uncertain as the current quality of evidence is low.

Open Science Framework ( https://doi.org/10.17605/OSF.IO/VW72N ).