Prehabilitation improves functional capacity and reduces severe complications in elective colorectal cancer surgery

OBJECTIVES: To evaluate the impact of preoperative prehabilitation on physical functional recovery, postoperative complications, and length of hospital stay (LOS) in patients undergoing elective colorectal cancer surgery. DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING AND PARTICIPANTS: A total of 11 RCTs involving 976 adult patients scheduled for elective colorectal cancer resection were included. METHODS: A systematic literature search was conducted in PubMed, Web of Science, Embase, and Scopus from inception to August 2025. The primary outcome was the change in the 6-minute walk test (Δ6MWT). Secondary outcomes included postoperative complications, severe complications, and LOS. Data were pooled using random-effects models, and the quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. RESULTS: Prehabilitation significantly and meaningfully improved postoperative functional capacity (mean difference = 32.95 meters, 95% CI, 15.34-50.57), with an effect size exceeding the minimal clinically important difference. Moderate heterogeneity (I = 36.6%) was observed and found to be multifactorial, with intervention modality, duration, patient age, and assessment timing identified as key contextual modifiers. The benefit was most pronounced with multimodal interventions, longer duration (3 weeks), in younger patients, and when assessed >4 weeks postoperatively. Prehabilitation was also associated with a significant reduction in the risk of severe postoperative complications (risk ratio = 0.65; 95% CI, 0.46-0.93). No significant differences were found in overall complications or LOS. CONCLUSIONS AND IMPLICATIONS: Prehabilitation significantly improves medium-term physical function and reduces severe complications after colorectal cancer surgery, with its optimal functional benefit emerging beyond the 4-week postoperative period. The effect is context-dependent, supporting a stratified implementation strategy: intensive programs for fitter patients and standardized programs for broader, frailer populations. These findings advocate for integrating prehabilitation into continuous "prehab-to-rehab" pathways with structured longer-term follow-up. Future research should standardize multitimepoint assessments and confirm the translation of functional gains into long-term outcomes.