SYSTEMATIC REVIEW article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1619959
This article is part of the Research TopicOptimizing Rectal Cancer Treatment: Evaluating Minimally Invasive Surgical Techniques and Patient SelectionView all 3 articles
Multimodal Prehabilitation is an Effective Strategy to Reduce Postoperative Complications and Improve Physical Function and Anxiety in Patients with Colorectal Cancer Undergoing Elective Surgery: A Systematic Review and Network Meta
Provisionally accepted
- 1School of Medicine, Tongji University, Shanghai, China
- 2Shanghai Prison General Hospital, Shanghai, China
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Background: Preoperative prehabilitation represents a viable approach to improve postoperative recovery and quality of life in colorectal cancer (CRC) patients, though debates persist regarding the efficacy of specific prehabilitation modalities.Objective: This study aims to compare and rank prehabilitation strategies for enhancing postoperative outcomes in CRC patients through a network meta-analysis, identifying the optimal preoperative prehabilitation method.We included randomized controlled trials (RCTs) assessing four prehabilitation strategies in CRC patients. Outcome measures focused on postoperative complications, hospital stay duration, 6-minute walk test, and states of anxiety and depression. The effect sizes for dichotomous outcomes were measured by odds ratios (OR), and for continuous outcomes by mean differences (MD) or standardized mean differences (SMD), with 95% credible intervals (CrIs).Results: Our analysis included 27 RCTs involving 2946 CRC patients. NMA results indicated that, compared to the control group (CON), only the multimodal (Mul) approach significantly reduced postoperative complications (OR: 0.47, 95%CrI: 0.26 to 0.85) and hospitalization time (MD: -1.17, 95CrI: -1.77 to -0.57). Moreover, Mul was the only strategy that improved pre-surgical 6-minute walk test results (MD: 27.22, 95CrI: 12.71 to 41.73) and anxiety levels (SMD: -0.69, 95CrI: -1.34 to -0.04), with 4 sustained improvements in the 6-minute walk test observed up to 4 weeks post-surgery (MD: 19.22, 95CrI: 5.94 to 32.50).The Mul prehabilitation program is the effective strategy for improving surgical outcomes in CRC patients. This comprehensive approach not only aids in reducing postoperative complications and shortening hospital stays but also enhances physical and psychological readiness before surgery.
Keywords: colorectal cancer, Prehabilitation, postoperative outcomes, multimodal intervention, Network meta-analysis
Received: 17 May 2025; Accepted: 31 Jul 2025.
Copyright: © 2025 Li, Liu, Wang, Song and Xie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ruimei Song, School of Medicine, Tongji University, Shanghai, China
Xufeng Xie, Shanghai Prison General Hospital, Shanghai, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.