Multimodal Prehabilitation in ERAS for Older Adults Undergoing Elective Colorectal Surgery

Overview

This systematic review and meta-analysis evaluated the integration of multimodal prehabilitation into ERAS protocols for elderly colorectal cancer patients. Results showed a significant improvement in functional capacity measured by the 6-minute walk test, but no significant differences in length of stay, postoperative complications, or quality of life.

Background

Enhanced recovery after surgery (ERAS) protocols aim to improve postoperative outcomes through standardized perioperative care. Multimodal prehabilitation, involving exercise, nutrition, psychological, and spiritual interventions, is proposed to optimize patients' condition before surgery. Elderly patients with colorectal cancer represent a vulnerable population where such interventions could potentially improve recovery. However, the effectiveness of combining multimodal prehabilitation with ERAS in this group remains unclear.

Data Highlights

Key Findings

• Six high-quality studies including 547 elderly colorectal cancer patients were analyzed.
• Multimodal prehabilitation significantly improved functional capacity as measured by the 6-minute walk test (MD 18.38 m; p=0.0404).
• No statistically significant differences were found in length of hospital stay, postoperative complications, or quality of life.
• Low heterogeneity was observed among studies for the 6MWT outcome (I2 = 3.7%).
• Subgroup analyses showed no differences based on study design or control group type.
• Current evidence suggests limited clinical impact of multimodal prehabilitation within ERAS for this population, though targeted interventions may hold promise.

Clinical Implications

While multimodal prehabilitation can enhance functional capacity preoperatively in elderly colorectal cancer patients, it does not currently demonstrate reductions in hospital stay or postoperative complications when integrated into ERAS protocols. Clinicians should consider individualized prehabilitation strategies and await further research to identify patient subgroups who may benefit most. Implementation should be balanced against resource use and patient preferences.

Conclusion

Multimodal prehabilitation within ERAS protocols modestly improves functional capacity but does not significantly affect other key postoperative outcomes in elderly colorectal cancer patients. Further targeted research is needed to optimize and validate these interventions.

References

1. Incorporating Multimodal Prehabilitation into ERAS Protocols for Older Adults: Systematic Review and Meta-Analysis
2. Colorectal Cancer. World Health Organization (2023)
3. Holt PR et al. (2009) Colon cancer and the elderly: from screening to treatment. Best Pract Res Clin Gastroenterol
4. Gustafsson UO et al. (2018) Guidelines for perioperative care in elective colorectal surgery: ERAS Society recommendations. World J Surg