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Vol. 27, Art. 4 (pp. 44-73)    |    2026       

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The role of prehabilitation in improving postoperative outcomes in colorectal cancer: A literature review

Zakharenko A.A., Zavgorodnyaya M.V., Ten O.A.

First Pavlov State Medical University of St. Petersburg
197022, Russia, Saint Petersburg, L'va Tolstogo str. 6/8

Brief summary

Colorectal cancer (CRC) ranks among the leading causes of cancer morbidity and mortality worldwide. Surgical intervention remains the mainstay of treatment; however, up to half of patients experience postoperative complications, which determine both prognosis and quality of life. The Enhanced Recovery After Surgery (ERAS) program outlines a rigorous methodology for managing patients before, during, and after surgery. However, the concept of prehabilitation, as a component of this strategy, currently lacks compelling evidence of its effectiveness. This is primarily due to the absence of a clear understanding regarding the impact of preoperative preparation components on the postoperative period. Objective. To analyze data from the past 10 years regarding the role of prehabilitation in patients with CRC in the context of surgical treatment. Materials and Methods. A literature review was conducted, including clinical studies, systematic reviews, and meta-analyses retrieved from PubMed, Cochrane Library, and eLibrary databases. The search was performed using the keywords: “colorectal cancer,” “prehabilitation,” “ERAS,” “nutrition,” “exercise therapy,” and “psychological support.” Discussion. Prehabilitation is a set of interventions aimed at enhancing functional reserves prior to surgery in order to mitigate surgical stress, improve perioperative outcomes, accelerate recovery, and enhance quality of life. Unimodal programs focusing on exercise demonstrated beneficial effects on functional status; however, clinically meaningful improvements were more pronounced with multimodal interventions. For example, in the PREHAB trial, after 4 weeks of prehabilitation, the rate of major complications decreased from 27.3% to 15.4% (p = 0.02), and over 80% of patients regained baseline functional capacity within 8 weeks postoperatively, compared to 40% without prehabilitation. Conversely, the large unimodal RCT PHYSSURG-C found no significant differences in the same key endpoints. Most investigators favor a multimodal approach due to its synergistic effect: exercise improves resilience to stress and functional status, nutrition supports protein synthesis and counters catabolism, while psychological support enhances adherence. Among elderly patients, complication rates were reduced by 51% with high protocol adherence. Potential economic benefits, mainly through reduced hospitalization, have been suggested but remain insufficiently studied. Evidence on long-term oncological outcomes is still scarce. Conclusion. Prehabilitation in CRC patients improves physical and psychological status, reduces hospital stay, and lowers complication rates, and thus may serve as a valuable adjunct to surgical treatment. The highest efficacy is demonstrated by multimodal programs lasting 4-6 weeks. However, due to methodological heterogeneity and variability of endpoints, the current evidence base remains limited, underscoring the need for further multicenter trials.


Key words

prehabilitation; colorectal cancer; accelerated recovery after surgery; colon cancer surgery; compliance; clinical nutrition; exercise therapy; psychological assistance.

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