Multimodal Prehabilitation in Patients Undergoing Complex Colorectal Surgery, Liver Resection, and Hyperthermic Intraperitoneal Chemotherapy (HIPEC): A Pilot Study on Feasibility and Potential Efficacy

SIMPLE SUMMARY: Surgery plays a key role in the treatment of metastatic bowel cancer. Over the last years, more patients with metastatic bowel cancer are surgically treated, leading to increased survival rates. However, the surgical procedure is associated with a high risk of complications after surgery (up to 75%), such as bleeding, wound healing disorders, anastomotic leakage, and medical complications. Research has shown that prehabilitation improves outcomes after surgery for bowel cancer: it lowers the risk of complications and reduces the length of stay after surgery. Prehabilitation is a process of improving a patient’s condition between the time of diagnosis and the surgical procedure to enable a patient to withstand this stressful event. Most prehabilitation programs comprise multiple modalities, including an exercise program, nutritional intervention, psychological support, and intoxication cessation support. It is suggested that multimodal prehabilitation might also improve outcomes after procedures for metastatic bowel cancer. This pilot study aimed to determine the feasibility and potential efficacy of a prehabilitation program for patients undergoing surgery for metastases from bowel cancer. ABSTRACT: Background: Surgery for complex primary and metastatic colorectal cancer (CRC), such as liver resection and hyperthermic intraperitoneal chemotherapy (HIPEC), in academic settings has led to improved survival but is associated with complications up to 75%. Prehabilitation has been shown to prevent complications in non-academic hospitals. This pilot study aimed to determine the feasibility and potential efficacy of a multimodal prehabilitation program in patients undergoing surgery in an academic hospital for complex primary and metastatic CRC. Methods: All patients awaiting complex colorectal surgery, liver resection, or HIPEC from July 2019 until January 2020 were considered potentially eligible. Feasibility was measured by accrual rate, completion rate, adherence to the program, satisfaction, and safety. To determine potential efficacy, postoperative outcomes were compared with a historical control group. Results: Sixteen out of twenty-five eligible patients (64%) commenced prehabilitation, and fourteen patients fully completed the intervention (88%). The adherence rate was 69%, as 11 patients completed >80% of prescribed supervised trainings. No adverse events occurred, and all patients expressed satisfaction with the program. The complication rate was significantly lower in the prehabilitation group (37.5%) than the control group (70.2%, p = 0.020). There was no difference in the type of complications. Conclusion: This pilot study illustrates that multimodal prehabilitation is feasible in the majority of patients undergoing complex colorectal cancer, liver resection, and HIPEC in an academic setting.