Multimodal prehabilitation in patients with colorectal cancer: a systematic review

Background. Patients with advanced colorectal cancer commonly demonstrate high frequency of sarcopenia (skeletal muscle depletion) and nutritional deficiency while being in need of complex surgical interventions. This led to the development of «multimodal prehabilitation» concept including physical training, nutritional and psychological support. Aim. We aim to summarize recent literature regarding the impact of prehabilitation on the surgical treatment of patients with colorectal cancer. Methods. PubMed, Cochrane Library and ClinicalTrials.gov databases were searched for relevant original studies published between January 2011 to December 2021. Results. Eight studies comprising 732 patients were included. The duration of prehabilitation ranged from 2 to 6 weeks,adherence – from 78% to 98%. All studies had functional tests as the primary end-point. Six studies used a 6-minute walk test to measure physical performance. Five studies showed an increase in functional walking capacity in the prehabilitation group, 1 study revealed a significant decrease in the level of anxiety and depression (according to the HADS scale) after prehabilitation. All studies did not demonstrate the impact of prehabilitation on postoperative complications and mortality as well as nutrition status of colorectal cancer patients. Conclusions. Heterogeneity of prehabilitation programs as well as the absence of randomized trials preclude wide adoption of multimodal prehabilitation. Standardized prehabilitation programs are needed to further understand the influence of prehabilitation on the clinical trajectory of patients with colorectal cancer. Also, the preliminary selection of high-risk patients is required to evaluate the clinical importance of prehabilitation.