Effect of Multimodal Prehabilitation vs Postoperative Rehabilitation on 30-Day Postoperative Complications for Frail Patients Undergoing Resection of Colorectal Cancer: A Randomized Clinical Trial
Carli F · Bousquet-Dion G · Awasthi R · Elsherbini N · Liberman S · Boutros M · Stein B · Charlebois P · Ghitulescu G · Morin N · Jagoe T · Scheede-Bergdahl C · Minnella EM · Fiore JF
JAMA Surgery · 2020
What the research tells us
Among frail or prefrail older colorectal-cancer patients, preoperative prehabilitation showed no clear advantage over postoperative rehabilitation for 30-day complication burden: adjusted CCI difference −3.2 (95% CI −11.8 to 5.3). The four-week walk-distance difference of 18.5 m (−20.2 to 57.3) was also nonsignificant. The intervals still allow meaningful benefit and do not demonstrate equivalence or no effect.
Scope & interpretation
Ten post-randomization exclusions, substantial secondary-outcome missingness, age/ASA imbalance and the missing-at-random imputation assumption matter. Population, comparator and implementation differ from PREHAB, so the trials are not simply opposing positive/negative results. A formal correction concerns author affiliations, not result values.
Study at a glance
- POPULATION & SAMPLE
- Two centres; patients aged ≥65 with Fried scores ≥2. Of 120 randomized, 110 entered the authors' intention-to-treat analysis.
- EXPOSURE / INTERVENTION / SUBJECT
- Four weeks of preoperative multimodal prehabilitation versus similar postoperative rehabilitation; both received standard enhanced recovery, with blinded assessors.
- OUTCOMES
- 30-day CCI and functional outcomes, interpreted with uncertainty intervals and missingness.
- TIME FRAME
- Four preoperative weeks, 30-day complication assessment and postoperative functional follow-up.
Editorial & review record
Record for v1.0 · Updated
Editorial responsibility: TAP Editorial Team
Scientific review
Not yet scientifically reviewed
Editorial note
Under the editorial responsibility of the TAP Editorial Team, this publication used AI assistance for content organization and editing. Scientific review is recorded separately on this page.
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How responsibilities and review are recorded ↗Scope of this reading note
JAMA web full-text methods/results, Tables 2–4 and article information, paired with the 2020 affiliation correction. Protocol, missingness and adherence supplements remain to be examined.
- Study funding
- Rossy Cancer Network and the Peri Operative Program; Immunotec supplied protein supplements.
- Competing interests
- Liberman disclosed other company relationships; consult the article. Complete author-by-author disclosures remain to be checked.
Project support
Founded and supported by Resilio.
Revision history
- · v1.0
Added the trial in frail older patients, retaining uncertainty intervals and linking its affiliation correction.