PhD Scientific Days 2024

Budapest, 9-10 July 2024

Poster Session O - Surgical Medicine

The Role of Trimodal Prehabilitation in Preparing for Colorectal Surgery: a Single-center, Randomized, Prospective Clinical Study

Author(s)

Nóra Suszták1,2, András Fülöp3, Lóránd Lakatos3, Dominic Herovi1, Petra Tímár1, József Golub4, Izabella Mihály4, József Tamás Marton4, Balázs Bánky3
1: Faculty of Medicine, Semmelweis University, Budapest, Hungary
2: Department of Surgery, St. Imre University Teaching Hospital, Budapest, Hungary
3: Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
4: Department of Surgery, St. Borbala Hospital, Tatabánya, Hungary

Text of the abstract

Introduction
Based on literature data, trimodal prehabilitation (TMP), a combination of preoperative physical activity, nutrition therapy, and anxiety treatment, can facilitate the complication-free early postoperative period following colorectal surgery.
Aims
Our aim was to assess the clinical effectiveness of TMP compared to the Enhanced Recovery After Surgery (ERAS) method among adult patients undergoing elective colorectal surgery.
Methods
We conducted a single-center, randomized, prospective clinical study with patients recruited between 2017 and 2022. All of benign, malignant colorectal resection and colorectal reconstuction patiens met the selection criteria. Patients gave prior informed consent to the study. After selection, we randomized to TMP vs. ERAS for interventional branches. Patients were followed up until the 60th day after surgery or until death, which included the monitoring of clinical and functional indicators (e.g. 6-minute walking distance (8MWD) and forced vital capacity (FVC)). Primary outcomes were overall mortality, overall morbidity and severe morbidity. Secondary outcomes were mortality and morbidity in dedicated subgroups. All endpoints were evaluated on days 7 and 30 after surgery.
Results
Over the period of 58 months, overall 344 patients were screened for eigibility. A total of 244 patients 104 (42,6%) in the ERAS and 140 (57,4%) in the TMP, were included. Main demographic and anthropometrical characteristics, comorbidities and pathological features of the tumor were statistically comparable between the subcohorts. At the time of surgery patients in the TMP group had a significant improvement in 6MWD and in FVC measured with incentive spirometry. However, at 8 weeks follow-up, there was no observable difference. There was no statistically significant difference detected in overall mortality, overall morbidity and severe morbidity at 7-days and 30-days. Patients in the ERAS subgroup with high myosteatosis had a significantly higher 7-days and 30-days morbidity rate comparing to patients in the TMP subgroup.
Conclusion
Our results suggest that TMP would not be beneficial for the whole population considering morbidity and mortality. Dedicated subgroups, such as patient with high myosteatosis could benefit from trimodal prehabilitation programs.
Funding: none