Preoperative multimodal prehabilitation before elective colorectal cancer surgery in patients with WHO performance status I or II: randomized clinical trial

Rasmus Dahlin Bojesen; Susanne Oksbjerg Dalton; Søren Thorgaard Skou; Lars Bo Jørgensen; Line Rosell Walker; Jens Ravn Eriksen; Camilla Grube; Tobias Freyberg Justesen; Christoffer Johansen; Gerrit Slooter; Franco Carli; Ismail Gögenur

doi:10.1093/bjsopen/zrad134

Preoperative multimodal prehabilitation before elective colorectal cancer surgery in patients with WHO performance status I or II: randomized clinical trial

Rasmus Dahlin Bojesen^*
, Susanne Oksbjerg Dalton
, Søren Thorgaard Skou
, Lars Bo Jørgensen
, Line Rosell Walker
, Jens Ravn Eriksen
, Camilla Grube
, Tobias Freyberg Justesen
, Christoffer Johansen
, Gerrit Slooter
, Franco Carli
, Ismail Gögenur

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

Abstract

BACKGROUND: Multimodal prehabilitation is a promising adjunct to the current surgical treatment pathway for colorectal cancer patients to further improve postoperative outcomes, especially for high-risk patients with low functional capacity. The aim of the present study was to test the effect of prehabilitation on immediate postoperative recovery.

METHOD: The study was designed as a RCT with two arms (intervention and control). The intervention consisted of 4 weeks of multimodal prehabilitation, with supervised physical training, nutritional support and medical optimization. The control group received standard of care. A total of 40 patients with colorectal cancer (WHO performance status I or II) undergoing elective surgery with curative intent were included. The primary outcome was postoperative recovery within the first 3 postoperative days, measured by Quality of Recovery-15, a validated questionnaire with a scoring range between 0 and 150 and a minimal clinically relevant difference of 8.

RESULTS: In total, 36 patients were analysed with 16 in the intervention group and 20 in the control group. The mean age of the included patients was 79 years. The overall treatment effect associated with the intervention was a 21.9 (95% c.i. 4.5-39.3) higher quality of recovery-15 score during the first 3 postoperative days compared to control, well above the minimal clinically relevant difference.

CONCLUSION: Four weeks of multimodal prehabilitation prior to elective curative intended colorectal cancer surgery in patients with WHO performance status I or II was associated with a clinically relevant improvement in postoperative recovery.Registration number: NCT04167436 (http://www.clinicaltrials.gov).

Original language	English
Article number	zrad134
Number of pages	10
Journal	BJS Open/ British Journal of Surgery
Volume	7
Issue number	6
DOIs	https://doi.org/10.1093/bjsopen/zrad134
Publication status	Published - 1 Nov 2023

Funding

The study was supported by charitable donations from the Axel Muusfeldts Fond, the Dagmar Marshall Fund, The Einar Willumsen Scholarship Foundation and The Beckett Foundation. Funding parties were not involved in the design, analyses or writing of this study. No support from the industry was received for conducting this study. S.T.S. is currently funded by a programme grant from Region Zealand (Exercise First) and two grants from the European Union's Horizon 2020 Research and Innovation Framework Programme, one from the European Research Council (MOBILIZE, grant agreement No. 801790) and the other under grant agreement No. 945377 (ESCAPE).

Funders	Funder number
Axel Muusfeldts Foundation
Dagmar Marshall Fund
Einar Willumsen Scholarship Foundation
European Union
European Research Council under the European Union	801790
Beckett Foundation	945377

Keywords

Postoperative quality
Classification
Complications
Capacity
Strength
Exercise
Validity
Sf-36

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10.1093/bjsopen/zrad134

Cite this

Bojesen, R. D., Dalton, S. O., Skou, S. T., Jørgensen, L. B., Walker, L. R., Eriksen, J. R., Grube, C., Justesen, T. F., Johansen, C., Slooter, G., Carli, F., & Gögenur, I. (2023). Preoperative multimodal prehabilitation before elective colorectal cancer surgery in patients with WHO performance status I or II: randomized clinical trial. BJS Open/ British Journal of Surgery, 7(6), Article zrad134. https://doi.org/10.1093/bjsopen/zrad134

@article{fc37f87043fb45de8b5c2273c9cb5d5a,

title = "Preoperative multimodal prehabilitation before elective colorectal cancer surgery in patients with WHO performance status I or II: randomized clinical trial",

abstract = "BACKGROUND: Multimodal prehabilitation is a promising adjunct to the current surgical treatment pathway for colorectal cancer patients to further improve postoperative outcomes, especially for high-risk patients with low functional capacity. The aim of the present study was to test the effect of prehabilitation on immediate postoperative recovery.METHOD: The study was designed as a RCT with two arms (intervention and control). The intervention consisted of 4 weeks of multimodal prehabilitation, with supervised physical training, nutritional support and medical optimization. The control group received standard of care. A total of 40 patients with colorectal cancer (WHO performance status I or II) undergoing elective surgery with curative intent were included. The primary outcome was postoperative recovery within the first 3 postoperative days, measured by Quality of Recovery-15, a validated questionnaire with a scoring range between 0 and 150 and a minimal clinically relevant difference of 8.RESULTS: In total, 36 patients were analysed with 16 in the intervention group and 20 in the control group. The mean age of the included patients was 79 years. The overall treatment effect associated with the intervention was a 21.9 (95\% c.i. 4.5-39.3) higher quality of recovery-15 score during the first 3 postoperative days compared to control, well above the minimal clinically relevant difference.CONCLUSION: Four weeks of multimodal prehabilitation prior to elective curative intended colorectal cancer surgery in patients with WHO performance status I or II was associated with a clinically relevant improvement in postoperative recovery.Registration number: NCT04167436 (http://www.clinicaltrials.gov).",

keywords = "Postoperative quality, Classification, Complications, Capacity, Strength, Exercise, Validity, Sf-36",

author = "Bojesen, \{Rasmus Dahlin\} and Dalton, \{Susanne Oksbjerg\} and Skou, \{S{\o}ren Thorgaard\} and J{\o}rgensen, \{Lars Bo\} and Walker, \{Line Rosell\} and Eriksen, \{Jens Ravn\} and Camilla Grube and Justesen, \{Tobias Freyberg\} and Christoffer Johansen and Gerrit Slooter and Franco Carli and Ismail G{\"o}genur",

note = "{\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.",

year = "2023",

month = nov,

day = "1",

doi = "10.1093/bjsopen/zrad134",

language = "English",

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Bojesen, RD , Dalton, SO , Skou, ST, Jørgensen, LB, Walker, LR, Eriksen, JR, Grube, C, Justesen, TF, Johansen, C, Slooter, G, Carli, F & Gögenur, I 2023, 'Preoperative multimodal prehabilitation before elective colorectal cancer surgery in patients with WHO performance status I or II: randomized clinical trial', BJS Open/ British Journal of Surgery, vol. 7, no. 6, zrad134. https://doi.org/10.1093/bjsopen/zrad134

Preoperative multimodal prehabilitation before elective colorectal cancer surgery in patients with WHO performance status I or II: randomized clinical trial. / Bojesen, Rasmus Dahlin ; Dalton, Susanne Oksbjerg ; Skou, Søren Thorgaard et al.
In: BJS Open/ British Journal of Surgery, Vol. 7, No. 6, zrad134, 01.11.2023.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Preoperative multimodal prehabilitation before elective colorectal cancer surgery in patients with WHO performance status I or II

T2 - randomized clinical trial

AU - Bojesen, Rasmus Dahlin

AU - Dalton, Susanne Oksbjerg

AU - Skou, Søren Thorgaard

AU - Jørgensen, Lars Bo

AU - Walker, Line Rosell

AU - Eriksen, Jens Ravn

AU - Grube, Camilla

AU - Justesen, Tobias Freyberg

AU - Johansen, Christoffer

AU - Slooter, Gerrit

AU - Carli, Franco

AU - Gögenur, Ismail

PY - 2023/11/1

Y1 - 2023/11/1

N2 - BACKGROUND: Multimodal prehabilitation is a promising adjunct to the current surgical treatment pathway for colorectal cancer patients to further improve postoperative outcomes, especially for high-risk patients with low functional capacity. The aim of the present study was to test the effect of prehabilitation on immediate postoperative recovery.METHOD: The study was designed as a RCT with two arms (intervention and control). The intervention consisted of 4 weeks of multimodal prehabilitation, with supervised physical training, nutritional support and medical optimization. The control group received standard of care. A total of 40 patients with colorectal cancer (WHO performance status I or II) undergoing elective surgery with curative intent were included. The primary outcome was postoperative recovery within the first 3 postoperative days, measured by Quality of Recovery-15, a validated questionnaire with a scoring range between 0 and 150 and a minimal clinically relevant difference of 8.RESULTS: In total, 36 patients were analysed with 16 in the intervention group and 20 in the control group. The mean age of the included patients was 79 years. The overall treatment effect associated with the intervention was a 21.9 (95% c.i. 4.5-39.3) higher quality of recovery-15 score during the first 3 postoperative days compared to control, well above the minimal clinically relevant difference.CONCLUSION: Four weeks of multimodal prehabilitation prior to elective curative intended colorectal cancer surgery in patients with WHO performance status I or II was associated with a clinically relevant improvement in postoperative recovery.Registration number: NCT04167436 (http://www.clinicaltrials.gov).

AB - BACKGROUND: Multimodal prehabilitation is a promising adjunct to the current surgical treatment pathway for colorectal cancer patients to further improve postoperative outcomes, especially for high-risk patients with low functional capacity. The aim of the present study was to test the effect of prehabilitation on immediate postoperative recovery.METHOD: The study was designed as a RCT with two arms (intervention and control). The intervention consisted of 4 weeks of multimodal prehabilitation, with supervised physical training, nutritional support and medical optimization. The control group received standard of care. A total of 40 patients with colorectal cancer (WHO performance status I or II) undergoing elective surgery with curative intent were included. The primary outcome was postoperative recovery within the first 3 postoperative days, measured by Quality of Recovery-15, a validated questionnaire with a scoring range between 0 and 150 and a minimal clinically relevant difference of 8.RESULTS: In total, 36 patients were analysed with 16 in the intervention group and 20 in the control group. The mean age of the included patients was 79 years. The overall treatment effect associated with the intervention was a 21.9 (95% c.i. 4.5-39.3) higher quality of recovery-15 score during the first 3 postoperative days compared to control, well above the minimal clinically relevant difference.CONCLUSION: Four weeks of multimodal prehabilitation prior to elective curative intended colorectal cancer surgery in patients with WHO performance status I or II was associated with a clinically relevant improvement in postoperative recovery.Registration number: NCT04167436 (http://www.clinicaltrials.gov).

KW - Postoperative quality

KW - Classification

KW - Complications

KW - Capacity

KW - Strength

KW - Exercise

KW - Validity

KW - Sf-36

U2 - 10.1093/bjsopen/zrad134

DO - 10.1093/bjsopen/zrad134

M3 - Article

C2 - 38060453

SN - 2474-9842

VL - 7

JO - BJS Open/ British Journal of Surgery

JF - BJS Open/ British Journal of Surgery

IS - 6

M1 - zrad134

ER -

Preoperative multimodal prehabilitation before elective colorectal cancer surgery in patients with WHO performance status I or II: randomized clinical trial

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