Pré-habilitação multimodal associada ao protocolo Enhanced Recovery After Surgery na cirurgia colorretal: impacto nos desfechos pós-operatórios

Lara  Marçal Machado; Gabriel  Fagundes Moreira; João Gabriel  Peixoto Santana; Nathália  Goulart Ferreira; Bruna  Dell’Acqua Cassão Rezende

Authors

Lara Marçal Machado Graduando em Medicina na Universidade Federal de Goiás UFG, Goiânia/GO, Brasil. Autor https://orcid.org/0009-0008-9673-9403
Gabriel Fagundes Moreira Graduando em Medicina na Universidade Federal de Goiás UFG, Goiânia/GO, Brasil. Autor https://orcid.org/0009-0006-1140-5929
João Gabriel Peixoto Santana Graduando em Medicina na Universidade Federal de Goiás UFG, Goiânia/GO, Brasil. Autor https://orcid.org/0009-0009-4093-491X
Nathália Goulart Ferreira Graduando em Medicina na Universidade Federal de Goiás UFG, Goiânia/GO, Brasil. Autor https://orcid.org/0009-0001-7089-0593
Bruna Dell’Acqua Cassão Rezende Médica Coloproctologista, Goiânia/GO, Brasil; Doutora em Ciência Cirúrgica Interdisciplinar, Goiânia/GO, Brasil; Professora Adjunta da Faculdade de Medicina da Universidade Federal de Goiás (FM-UFG), Goiânia/GO, Brasil. Autor https://orcid.org/0000-0003-1486-5745

Keywords:

Colorectal surgery, Enhanced postoperative recovery, Postoperative complications, Preoperative exercise, Rehabilitation

Abstract

Recovery after colorectal surgery remains a significant challenge, particularly in patients with low functional capacity and a higher risk of complications. In this context, the combination of multimodal prehabilitation with the Enhanced Recovery After Surgery protocol has been proposed as a strategy to better prepare patients for surgical stress and enhance postoperative recovery. This review analyzed studies published between 2019 and 2026 to evaluate the impact of this approach on postoperative outcomes. The findings demonstrated consistent improvements in functional capacity, reflected by better performance in the Six-minute Walk Test, as well as evidence of faster recovery and greater adherence to Enhanced Recovery After Surgery components. Although the effects on postoperative complications and length of hospital stay were variable, the benefits were more pronounced in patients with lower physiological reserve. Therefore, multimodal prehabilitation stands out as a promising tool to optimize perioperative care, reinforcing the importance of an individualized approach focused on the patient’s overall recovery.

References

Molenaar CJL, van Rooijen SJ, Fokkenrood HJP, Roumen RMH, Janssen L, Slooter GD. Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery. Cochrane Database Syst Rev. 2023;5(5):CD013259.

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 Jr. 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. 2020;155(3):233-42.

van Rooijen S, Carli F, Dalton S, Thomas G, Bojesen R, Le Guen M, Barizien N, Awasthi R, Minnella E, Beijer S, Martínez-Palli G, van Lieshout R, Gögenur I, Feo C, Johansen C, Scheede-Bergdahl C, Roumen R, Schep G, Slooter G. 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. 2019;19(1):98.

Gillis C, Hasil L, Keane C, Brassard D, Kiernan F, Bellafronte NT, Culos-Reed SN, Gramlich L, Ljungqvist O, Fenton TR. A multimodal prehabilitation class for Enhanced Recovery After Surgery: a pragmatic randomised type 1 hybrid effectiveness-implementation trial. Br J Anaesth. 2026;136(4):1166-78.

Srinivasan A, Yi KM, Sharma D, Mantoo SK. Integrating multimodal prehabilitation into enhanced recovery after surgery programs (MPhERAS) for elderly patients: a systematic review and meta-analysis of randomized controlled trials and cohort studies. Tech Coloproctol. 2026;30(1):28.

Widanage N, Almonib A, Gunathilaka K. The effects of multimodal prehabilitation on postoperative outcomes in colorectal surgery: a systematic review and meta-analysis. Cureus.

;17(10):e95032.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

Tai R, Yang F, Wang J, Wan S, Xiang Q, Cheng Y, Fang F, Sun J. Evaluating the impact of a modified multi-modal prehabilitation program on perioperative outcomes in Chinese patients undergoing colorectal cancer surgery. Front Surg. 2026;13:1703293.

Gloor S, Misirlic M, Frei-Lanter C, Herzog P, Müller P, Schäfli-Thurnherr J, Lamdark T, Schregel D, Wyss R, Unger I, Gisi D, Greco N, Mungo G, Wirz M, Raptis DA, Tschuor C,

Breitenstein S. 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. 2022;407(3):897-907.