CoChat
Sign Up
Cited by 539

The DOI matches its Crossref record; 3 of the 3 references it cites were found in a registry or an index.

Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial

Molenaar, Charlotte Johanna Laura, Minnella, Enrico Maria, Coca-Martinez, Miquel, ten Cate, David Wouter Gerard, Regis, Marta, Awasthi, Rashami, Martínez-Palli, Graciela, López-Baamonde, Manuel, Sebio-Garcia, Raquel, Feo, Carlo Vittorio, van Rooijen, Stefanus Johannes, Schreinemakers, Jennifer Marijke Janneke, Bojesen, Rasmus Dahlin, Gögenur, Ismail, van den Heuvel, Edwin R., Carli, Francesco, Slooter, Gerrit Dirk, PREHAB Study Group, Roumen, Rudi M.H., Janssen, Loes, Dieleman, Jeanne, Rademakers, Nicky, Van Erven, Cathrin, Schep, Goof, van Lankvelt, Suzanne A.L.M., Beijer, Sandra, Van der Meij, Wout, Lakshmi Tahasildar, Bhagya, Oksbjerg Dalton, Susanne, Asbert Sagasti, Rosa, Ubre, Marta, Campero, Betina, Siso, Marina, Risco, Raquel, Teres, Silvia, Lacy, Antonio M, De Troia, Alessandro, Grazzi, Giovanni·2023·JAMA Surgery
DOI 10.1001/jamasurg.2023.0198
Open this paper in CoChat — free account

Abstract

Importance: Colorectal surgery is associated with substantial morbidity rates and a lowered functional capacity. Optimization of the patient’s condition in the weeks prior to surgery may attenuate these unfavorable sequelae. Objective: To determine whether multimodal prehabilitation before colorectal cancer surgery can reduce postoperative complications and enhance functional recovery. Design, Setting, and Participants: The PREHAB randomized clinical trial was an international, multicenter trial conducted in teaching hospitals with implemented enhanced recovery after surgery programs. Adult patients with nonmetastasized colorectal cancer were assessed for eligibility and randomized to either prehabilitation or standard care. Both arms received standard perioperative care. Patients were enrolled from June 2017 to December 2020, and follow-up was completed in December 2021. However, this trial was prematurely stopped due to the COVID-19 pandemic. Interventions: The 4-week in-hospital supervised multimodal prehabilitation program consisted of a high-intensity exercise program 3 times per week, a nutritional intervention, psychological support, and a smoking cessation program when needed. Main Outcomes and Measures: Comprehensive Complication Index (CCI) score, number of patients with CCI score more than 20, and improved walking capacity expressed as the 6-minute walking distance 4 weeks postoperatively. Results: In the intention-to-treat population of 251 participants (median [IQR] age, 69 [60-76] years; 138 [55%] male), 206 (82%) had tumors located in the colon and 234 (93%) underwent laparoscopic- or robotic-assisted surgery. The number of severe complications (CCI score >20) was significantly lower favoring prehabilitation compared with standard care (21 of 123 [17.1%] vs 38 of 128 [29.7%]; odds ratio, 0.47 [95% CI, 0.26-0.87]; P = .02). Participants in prehabilitation encountered fewer medical complications (eg, respiratory) compared with participants receiving standard care (19 of 123 [15.4%] vs 35 of 128 [27.3%]; odds ratio, 0.48 [95% CI, 0.26-0.89]; P = .02). Four weeks after surgery, 6-minute walking distance did not differ significantly between groups when compared with baseline (mean difference prehabilitation vs standard care 15.6 m [95% CI, −1.4 to 32.6]; P = .07). Secondary parameters of functional capacity in the postoperative period generally favored prehabilitation compared with standard care. Conclusions and Relevance: This PREHAB trial demonstrates the benefit of a multimodal prehabilitation program before colorectal cancer surgery as reflected by fewer severe and medical complications postoperatively and an optimized postoperative recovery compared with standard care. Trial Registration: trialregister.nl Identifier: NTR5947

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamasurg.2023.0198

Cites

3 of 3 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

Show all 3 references

Research works printed but not linked: 36

  1. Perera, 2021, Global demand for cancer surgery and an estimate of the optimal surgical and anaesthesia workforce between 2018 and 2040: a population-based modelling study., Lancet Oncol, 22, 182, 10.1016/S1470-2045(20)30675-6 · DOI
  2. Sung, 2021, Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries., CA Cancer J Clin, 71, 209, 10.3322/caac.v71.3 · DOI
  3. Sharp, 2020, A NSQIP analysis of trends in surgical outcomes for rectal cancer: what can we improve upon?, Am J Surg, 220, 401, 10.1016/j.amjsurg.2020.01.004 · DOI
  4. Lawrence, 2004, Functional independence after major abdominal surgery in the elderly., J Am Coll Surg, 199, 762, 10.1016/j.jamcollsurg.2004.05.280 · DOI
  5. Stabenau, 2018, Functional trajectories before and after major surgery in older adults., Ann Surg, 268, 911, 10.1097/SLA.0000000000002659 · DOI
  6. Steffens, 2021, Preoperative cardiopulmonary exercise test associated with postoperative outcomes in patients undergoing cancer surgery: a systematic review and meta-analyses., Ann Surg Oncol, 28, 7120, 10.1245/s10434-021-10251-3 · DOI
  7. Wischmeyer, 2018, American society for enhanced recovery and perioperative quality initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway., Anesth Analg, 126, 1883, 10.1213/ANE.0000000000002743 · DOI
  8. Molenaar, 2021, Contradictory guidelines for colorectal cancer treatment intervals., Lancet Oncol, 22, 167, 10.1016/S1470-2045(20)30738-5 · DOI
  9. Molenaar, 2021, Conflicting guidelines: a systematic review on the proper interval for colorectal cancer treatment., World J Surg, 45, 2235, 10.1007/s00268-021-06075-7 · DOI
  10. Barker, 2013, Preoperative immunonutrition and its effect on postoperative outcomes in well-nourished and malnourished gastrointestinal surgery patients: a randomised controlled trial., Eur J Clin Nutr, 67, 802, 10.1038/ejcn.2013.117 · DOI
  11. Bousquet-Dion, 2018, Evaluation of supervised multimodal prehabilitation programme in cancer patients undergoing colorectal resection: a randomized control trial., Acta Oncol, 57, 849, 10.1080/0284186X.2017.1423180 · DOI
  12. Burden, 2017, Pre-operative oral nutritional supplementation with dietary advice versus dietary advice alone in weight-losing patients with colorectal cancer: single-blind randomized controlled trial., J Cachexia Sarcopenia Muscle, 8, 437, 10.1002/jcsm.v8.3 · DOI
  13. Minnella, 2020, Effect of two different pre-operative exercise training regimens before colorectal surgery on functional capacity: a randomised controlled trial., Eur J Anaesthesiol, 37, 969, 10.1097/EJA.0000000000001215 · DOI
  14. Polakowski, 2019, Impact of the preoperative use of synbiotics in colorectal cancer patients: a prospective, randomized, double-blind, placebo-controlled study., Nutrition, 58, 40, 10.1016/j.nut.2018.06.004 · DOI
  15. Bolshinsky, 2018, Multimodal prehabilitation programs as a bundle of care in gastrointestinal cancer surgery: a systematic review., Dis Colon Rectum, 61, 124, 10.1097/DCR.0000000000000987 · DOI
  16. Moran, 2016, The ability of prehabilitation to influence postoperative outcome after intra-abdominal operation: a systematic review and meta-analysis., Surgery, 160, 1189, 10.1016/j.surg.2016.05.014 · DOI
  17. Perry, 2021, Pre-admission interventions (prehabilitation) to improve outcome after major elective surgery: a systematic review and meta-analysis., BMJ Open, 11, 10.1136/bmjopen-2021-050806 · DOI
  18. Molenaar, 2022, Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery., Cochrane Database Syst Rev, 5
  19. Gustafsson, 2019, Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS®) society recommendations: 2018., World J Surg, 43, 659, 10.1007/s00268-018-4844-y · DOI
  20. van Rooijen, 2019, Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation., BMC Cancer, 19, 98, 10.1186/s12885-018-5232-6 · DOI
  21. Levett, 2018, Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation., Br J Anaesth, 120, 484, 10.1016/j.bja.2017.10.020 · DOI
  22. Minnella, 2018, Prehabilitation and functional recovery for colorectal cancer patients., Eur J Surg Oncol, 44, 919, 10.1016/j.ejso.2018.04.016 · DOI
  23. Fearon, 2005, Enhanced recovery after surgery: a consensus review of clinical care for patients undergoing colonic resection., Clin Nutr, 24, 466, 10.1016/j.clnu.2005.02.002 · DOI
  24. Slankamenac, 2013, The comprehensive complication index: a novel continuous scale to measure surgical morbidity., Ann Surg, 258, 1, 10.1097/SLA.0b013e318296c732 · DOI
  25. Minnella, 2019, The impact of improved functional capacity before surgery on postoperative complications: a study in colorectal cancer., Acta Oncol, 58, 573, 10.1080/0284186X.2018.1557343 · DOI
  26. Pecorelli, 2016, The six-minute walk test as a measure of postoperative recovery after colorectal resection: further examination of its measurement properties., Surg Endosc, 30, 2199, 10.1007/s00464-015-4478-1 · DOI
  27. ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories, 2002, ATS statement: guidelines for the six-minute walk test., Am J Respir Crit Care Med, 166, 111, 10.1164/ajrccm.166.1.at1102 · DOI · Paper page
  28. Thompson, 2017, Oncology evidence-based nutrition practice guideline for adults., J Acad Nutr Diet, 117, 297, 10.1016/j.jand.2016.05.010 · DOI
  29. Berkel, 2022, Effects of community-based exercise prehabilitation for patients scheduled for colorectal surgery with high risk for postoperative complications: results of a randomized clinical trial., Ann Surg, 275, e299, 10.1097/SLA.0000000000004702 · DOI
  30. Carli, 2020, Effect of multimodal prehabilitation vs postoperative rehabilitation on 30-day postoperative complications for frail patients undergoing resection of colorectal cancer: a randomized clinical trial., JAMA Surg, 155, 233, 10.1001/jamasurg.2019.5474 · DOI · Paper page
  31. Gloor, 2022, Prehabilitation in patients undergoing colorectal surgery fails to confer reduction in overall morbidity: results of a single-center, blinded, randomized controlled trial., Langenbecks Arch Surg, 407, 897, 10.1007/s00423-022-02449-0 · DOI
  32. Onerup, 2022, Effect of short-term homebased pre- and postoperative exercise on recovery after colorectal cancer surgery (PHYSSURG-C): a randomized clinical trial., Ann Surg, 275, 448, 10.1097/SLA.0000000000004901 · DOI
  33. Heger, 2020, A systematic review and meta-analysis of physical exercise prehabilitation in major abdominal surgery (PROSPERO 2017 CRD42017080366)., J Gastrointest Surg, 24, 1375, 10.1007/s11605-019-04287-w · DOI
  34. Heldens, 2017, The association between performance parameters of physical fitness and postoperative outcomes in patients undergoing colorectal surgery: an evaluation of care data., Eur J Surg Oncol, 43, 2084, 10.1016/j.ejso.2017.08.012 · DOI
  35. Cuijpers, 2022, Relation between preoperative aerobic fitness estimated by steep ramp test performance and postoperative morbidity in colorectal cancer surgery: prospective observational study., Br J Surg, 109, 155, 10.1093/bjs/znab292 · DOI
  36. Silver, 2022, Physical and psychological health behavior changes during the COVID-19 pandemic that may inform surgical prehabilitation: a narrative review., Curr Anesthesiol Rep, 12, 109, 10.1007/s40140-022-00520-6 · DOI

Cited by

Sorted by citations

See all 539

Metadata

Authors
Molenaar, C. J. L., Minnella, E. M., Coca-Martinez, M., ten Cate, D. W. G., Regis, M., Awasthi, R., Martínez-Palli, G., López-Baamonde, M., Sebio-Garcia, R., Feo, C. V., van Rooijen, S. J., Schreinemakers, J. M. J., Bojesen, R. D., Gögenur, I., van den Heuvel, E. R., Carli, F., Slooter, G. D., PREHAB Study Group, Roumen, R. M. H., Janssen, L., Dieleman, J., Rademakers, N., Van Erven, C., Schep, G., van Lankvelt, S. A. L. M., Beijer, S., Van der Meij, W., Lakshmi Tahasildar, B., Oksbjerg Dalton, S., Asbert Sagasti, R., Ubre, M., Campero, B., Siso, M., Risco, R., Teres, S., Lacy, A. M., De Troia, A., & Grazzi, G.
Venue
JAMA Surgery
Publisher
American Medical Association (AMA)
Published
2023-06-01
Volume
158
Issue
6
Pages
572
ISSN
2168-6254
DOI
10.1001/jamasurg.2023.0198
Cited by
539
References
3
Language
en

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

How to cite

Cite CoChat for the checks on this page, and the paper for its own findings.

This page
CoChat. (2026). Citation check: Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial. https://app.cochat.ai/papers/10.1001/jamasurg.2023.0198
The paper
Molenaar, C. J. L., Minnella, E. M., Coca-Martinez, M., ten Cate, D. W. G., Regis, M., Awasthi, R., Martínez-Palli, G., López-Baamonde, M., Sebio-Garcia, R., Feo, C. V., van Rooijen, S. J., Schreinemakers, J. M. J., Bojesen, R. D., Gögenur, I., van den Heuvel, E. R., Carli, F., Slooter, G. D., PREHAB Study Group, Roumen, R. M. H., . . . Grazzi, G. (2023). Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial. JAMA Surgery. https://doi.org/10.1001/jamasurg.2023.0198