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Improving Outcomes in Oncological Colorectal Surgery by Prehabilitation

Bruns, Emma R.J., MD; van Rooijen, Stefanus J., PhD; Argillander, Tanja E., MD; van der Zaag, Edwin S., PhD; van Grevenstein, Wilhelmina M.U., PhD; van Duijvendijk, Peter, PhD; Buskens, Christianne J., PhD; Bemelman, Willem A., PhD; van Munster, Barbara C., PhD; Slooter, Gerrit D., PhD; van den Heuvel, Baukje, PhD

American Journal of Physical Medicine & Rehabilitation: March 2019 - Volume 98 - Issue 3 - p 231–238
doi: 10.1097/PHM.0000000000001025
Analysis & Perspective
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Introduction The cornerstone in the treatment of colorectal cancer is surgery. A surgical event poses a significant risk of decreased functional decline and impaired health-related quality of life. Prehabilitation is defined as the multimodal preoperative enhancement of a patient's condition. It may serve as a strategy to improve postoperative outcomes. Prehabilitation requires a multidisciplinary effort of medical health care professionals and a behavioral change of the patient.

Methods The goal of prehabilitation is threefold: (1) to reduce postoperative complications, (2) to enhance and accelerate the recovery of the patient, and (3) to improve overall quality of life. In this article, we introduce the FIT model illustrating a possible framework toward the implementation of both evidence-based and tailor-made prehabilitation for patients undergoing surgery for colorectal cancer.

Results The model is composed of three pillars: “facts” (how to screen patients and evidence on what content to prescribe), “integration” (data of own questionnaires assessing motivation of patients and specialists), and finally “tools” (which outcome measurements to use).

Discussion Developing implementable methods and defining standardized outcome instruments will help establish a solid base for patient-centered prehabilitation programs. Any party introducing prehabilitation requiring multidisciplinary teamwork and behavioral change can potentially use this framework.

From the Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands (ERJB, TEA, ESvdZ, PvD); Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands (ERJB, CJB, WAB); Department of Surgery, Maxima Medical Center, Eindhoven, the Netherlands (SJvR, GDS); Department of Surgery, University Medical Center, Utrecht, the Netherlands (WMUvG); Department of Geriatrics, Gelre Hospitals, Apeldoorn, the Netherlands (BCvM); Department of Internal/Geriatric Medicine, University Medical Center, Groningen, the Netherlands (BCvM); and Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands (BvdH).

All correspondence should be addressed to: Emma R.J. Bruns, MD, Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, the Netherlands.

All authors confirm that they have contributed to the submission according to the requirements of the American Journal of Physical Medicine and Prehabilitation.

Emma R.J. Bruns is in training.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ajpmr.com).

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