Why Do Prehabilitation Studies Differ? Patient Selection and Program Design in Colorectal Cancer Surgery

Background Prehabilitation (PH) aims to optimize postoperative outcomes in patients with colorectal cancer (CRC), yet randomized trials have shown variable benefits. This meta-analysis investigated factors contributing to heterogeneous effects, including patient age, intervention duration, and program composition. The objectives were to evaluate the efficacy of PH on postoperative recovery and outcomes and identify factors influencing its effects. Methods Randomized controlled trials (RCTs) were searched in PubMed, Embase, Web of Science, and Cochrane Library from database inception to Sep. 2024. Postoperative recovery included functional outcomes (eg, 6-minute walk test [6MWT] and grip strength), while postoperative outcomes included complications, readmission, and mortality. Data were pooled using random-effects models, with sensitivity and subgroup analyses performed. Results Sixteen RCTs were included. PH improved 6MWT performance (SMD 0.23, 95% CI 0.11-0.35) and reduced 30-day complications (RR 0.77, 95% CI 0.62-0.95). No significant effects were observed on other recovery indicators or outcomes, including length of stay, readmission, reoperation, and mortality. Subgroup analysis suggested greater benefits from multimodal PH in patients aged <70 years. Conclusion PH may improve functional recovery and reduce 30-day complications after CRC surgery, but its effects vary according to patient characteristics and intervention strategies. Although multimodal programs and younger patients may derive greater benefits, these findings are hypothesis-generating and require validation. Further high-quality RCTs are needed to establish optimal PH strategies for specific patient populations.