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BMC Cancer. 2019 Jan 22;19(1):98. doi: 10.1186/s12885-018-5232-6.

Multimodal prehabilitation in colorectal cancer patients to improve functional capacity and reduce postoperative complications: the first international randomized controlled trial for multimodal prehabilitation.

Author information

Department of Surgical Oncology, Máxima Medical Center, Veldhoven, the Netherlands.
Department of Anesthesiology, the Montréal General Hospital, McGill University, Montréal, Canada.
Danish Cancer Society Research Center, Copenhagen, Denmark.
Department of Surgery, Center for Surgical Science, Zealand University Hospital, Køge, Denmark.
Department of Anesthesiology, Foch Hôpital, Paris, France.
Department of Sports Medicine, Foch Hôpital, Paris, France.
Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
Department of Anesthesiology, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
Department of Nutrition, Máxima Medical Center, Veldhoven, the Netherlands.
Department of Surgery, S. Anna University Hospital, Ferrara, Italy.
Department of Oncology, Finsen Center, Rigshospitalet, Copenhagen, Denmark.
Department of Kinesiology and Physical Education, McGill University, Montréal, Canada.
Department of Sports Medicine, Máxima Medical Center, Veldhoven, the Netherlands.
Department of Surgical Oncology, Máxima Medical Center, Veldhoven, the Netherlands.
Department of Surgery, Máxima Medical Center, P.O. Box 7777, Veldhoven, the Netherlands.



Colorectal cancer (CRC) is the second most prevalent type of cancer in the world. Surgery is the only curative option. However, postoperative complications occur in up to 50% of patients and are associated with higher morbidity and mortality rates, lower health related quality of life (HRQoL) and increased expenditure in health care. The number and severity of complications are closely related to preoperative functional capacity, nutritional state, psychological state, and smoking behavior. Traditional approaches have targeted the postoperative period for rehabilitation and lifestyle changes. However, recent evidence shows that the preoperative period might be the optimal moment for intervention. This study will determine the impact of multimodal prehabilitation on patients' functional capacity and postoperative complications.


This international multicenter, prospective, randomized controlled trial will include 714 patients undergoing colorectal surgery for cancer. Patients will be allocated to the intervention group, which will receive 4 weeks of prehabilitation (group 1, prehab), or the control group, which will receive no prehabilitation (group 2, no prehab). Both groups will receive perioperative care in accordance with the enhanced recovery after surgery (ERAS) guidelines. The primary outcomes for measurement will be functional capacity (as assessed using the six-minute walk test (6MWT)) and postoperative status determined with the Comprehensive Complication Index (CCI). Secondary outcomes will include HRQoL, length of hospital stay (LOS) and a cost-effectiveness analysis.


Multimodal prehabilitation is expected to enhance patients' functional capacity and to reduce postoperative complications. It may therefore result in increased survival and improved HRQoL. This is the first international multicenter study investigating multimodal prehabilitation for patients undergoing colorectal surgery for cancer.


Trial Registry: NTR5947 - date of registration: 1 August 2016.


Colorectal cancer; Colorectal surgery; Comprehensive complication index; Enhanced recovery after surgery; Functional capacity; Postoperative complications; Prehabilitation

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