The effectiveness of multimodal prehabilitation on functional capacity and clinical outcomes in patients undergoing elective laparoscopic colorectal cancer surgery: a systematic review of meta-analysis of randomized controlled trials.

purposeTo identify the effects of a preoperative multimodal prehabilitation intervention on functional capacity, postoperative complications, and quality of life in adult patients undergoing surgery for colorectal cancer.

methodsThis study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. X L and YH H searched PubMed, CENTRAL, EMBASE, CINAHL, and Web of Science for studies published from inception to May 16, 2025. We screened only randomized controlled trials of multimodal prehabilitation interventions performed before surgery for elective colorectal cancer in adults, focusing on their reported primary outcomes (6-min walk distance (6MWD) and complications) and secondary outcomes (length of hospital stay, emergency department visits, readmissions, adherence, etc.). YH H and Z T independently extracted the study characteristics and data, and assessed the risk of bias. In cases of doubt or disagreement, a third reviewing author (LL J) assessed the eligibility of the trial and then discussed it until a consensus was reached.

resultsWe analyzed 868 patients with CRC from nine randomized controlled trials. Multimodal prehabilitation is a promising strategy for modestly improving 6MWD preoperatively (mean difference (MD) 59.03 m, 95% confidence interval (CI) 6.85 to 111.21; P = 0.03) and at 8 weeks (MD 26.93 m, 95% CI 7.85 to 46.02; P = 0.006) postoperatively, but not at 4 weeks postop (MD 43.01 m, 95% CI 0.96 to 85.07; P = 0.05). There is a lack of significant differences in postoperative complications (RR 0.92, 95% CI 0.76 to 1.11; P = 0.37), emergency department visits (RR 0.92, 95% CI 0.54 to 1.32; P = 0.47), and readmission rates (RR 0.85, 95% CI 0.67 to 1.76; P = 0.74). The overall strength of the evidence is tempered by a high risk of bias across the included studies. These limitations suggest that while promising for functional outcomes, broader clinical benefits require further confirmation in higher-quality trials. In addition, further analysis was hampered by the wide variation in how studies defined and reported adherence. However, we can observe that adherence to the various components of the intervention program fluctuates mainly between 40% and 90%, which need to be further improved.

conclusionIn conclusion, this meta-analysis suggests that multimodal prehabilitation is a promising strategy for modestly improving functional capacity (as measured by the 6MWT) in patients scheduled for colorectal cancer surgery. However, based on the current evidence, its effect on reducing postoperative complications, hospital readmissions, or improving quality of life remains inconclusive. The observed benefits on functional outcomes should be interpreted with caution due to heterogeneity in interventions and the methodological limitations of the included trials. Future large-scale, high-quality RCTs with standardized protocols and comprehensive outcome assessment are needed to definitively establish its efficacy on clinically hard endpoints and to guide widespread implementation. IMPLICATIONS FOR CANCER SURVIVORS: Multimodal prehabilitation for CRC patients is a complex multidisciplinary intervention that offers unique advantages in terms of improving patients' preoperative functional reserve and postoperative clinical outcomes.