{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T03:44:00Z","timestamp":1777866240805,"version":"3.51.4"},"reference-count":38,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Introduction: While enhanced recovery after surgery (ERAS) programs are widely implemented to reduce postoperative complications of colorectal cancer surgery, evidence for trimodal prehabilitation is inconsistent. We compared prehabilitation+ERAS versus ERAS alone, and explored patient subgroups most likely to benefit from targeted prehabilitation. Methods: A prospective, single-center parallel cohort study was conducted from October 2017 to August 2022. Consecutive adults undergoing elective colorectal surgery received ERAS alone or a 3\u20136-week trimodal prehabilitation programme (nutritional optimization, aerobic training, psychological preparation), followed by ERAS. Primary outcomes were overall postoperative morbidity at 7 and 30 days. Secondary outcomes included mortality, severe morbidity (Clavien\u2013Dindo \u2265 3), 30-day readmission, and ICU\/ward length of stay. Results: Of 344 screened patients, 244 were analyzed (ERAS n = 104; prehabilitation n = 140) with comparable baseline characteristics. Prehabilitation improved 6 min walk distance and incentive spirometry FVC by the time of surgery (p &lt; 0.001 and p = 0.001, respectively), but between-group differences were not sustained at 8 weeks. Overall 7- and 30-day morbidity and mortality, severe morbidity, 30-day readmission, and length of stay did not differ between cohorts. In exploratory subgroup analyses, myosteatosis was associated with higher 7- and 30-day morbidity in the ERAS cohort (7% vs. 28% and 11.6% vs. 40%, respectively), whereas this contrast was not observed under prehabilitation. Among myosteatotic patients, prehabilitation was associated with lower 7-day morbidity (p = 0.045). Frailty was associated with severe morbidity, irrespective of allocation. Discussion: Trimodal prehabilitation improved preoperative functional measures but did not reduce short-term complications overall. CT-defined myosteatosis may help target prehabilitation to higher-risk patients.<\/jats:p>","DOI":"10.3390\/nu18091369","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T19:24:51Z","timestamp":1777317891000},"page":"1369","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Identifying Patients with Colorectal Cancer Likely to Benefit from a Trimodal Prehabilitation Prior to Surgery"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7971-541X","authenticated-orcid":false,"given":"N\u00f3ra","family":"Suszt\u00e1k","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary"},{"name":"Department of Surgery, St. Imre University Teaching Hospital, 1115 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e1s","family":"F\u00fcl\u00f6p","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L\u00f3r\u00e1nd L\u00e1szl\u00f3","family":"Lakatos","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominic","family":"Herovi","sequence":"additional","affiliation":[{"name":"Department of Urology, University Hospital of Z\u00fcrich,  8008 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9786-0245","authenticated-orcid":false,"given":"Junghyun","family":"Cho","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petra","family":"T\u00edm\u00e1r","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f3zsef","family":"Golub","sequence":"additional","affiliation":[{"name":"Department of Surgery, St. Borbala Hospital, 2800 Tatab\u00e1nya, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Izabella","family":"Mih\u00e1ly","sequence":"additional","affiliation":[{"name":"Department of Surgery, St. Borbala Hospital, 2800 Tatab\u00e1nya, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f3zsef Tam\u00e1s","family":"Marton","sequence":"additional","affiliation":[{"name":"Department of Surgery, St. Borbala Hospital, 2800 Tatab\u00e1nya, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Attila","family":"Szij\u00e1rt\u00f3","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4297-9072","authenticated-orcid":false,"given":"Bal\u00e1zs","family":"B\u00e1nky","sequence":"additional","affiliation":[{"name":"Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"ref_1","unstructured":"(2024, March 01). Observatory WGC: Estimated Number of Deaths Worldwide, Both Sexes, All Ages (Graph). Available online: https:\/\/gco.iarc.fr\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1810","DOI":"10.1002\/bjs.9318","article-title":"Population-based cohort study comparing 30- and 90-day institutional mortality rates after colorectal surgery","volume":"100","author":"Byrne","year":"2013","journal-title":"Br. J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1001\/archsurg.140.3.278","article-title":"Postoperative mortality and morbidity in French patients undergoing colorectal surgery: Results of a prospective multicenter study","volume":"140","author":"Alves","year":"2005","journal-title":"Arch. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1177\/000313480707301002","article-title":"Outcomes of right and left colectomy at academic centers","volume":"73","author":"Hinojosa","year":"2007","journal-title":"Am. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1016\/S1470-2045(09)70031-2","article-title":"Exercise intolerance in cancer and the role of exercise therapy to reverse dysfunction","volume":"10","author":"Jones","year":"2009","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1007\/s00268-018-4844-y","article-title":"Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS\u00ae) Society Recommendations: 2018","volume":"43","author":"Gustafsson","year":"2019","journal-title":"World J. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Wind, J., Hofland, J., Preckel, B., Hollmann, M.W., Bossuyt, P.M., Gouma, D.J., van Berge Henegouwen, M.I., Fuhring, J.W., Dejong, C.H., and van Dam, R.M. (2006). Perioperative strategy in colonic surgery; LAparoscopy and\/or FAst track multimodal management versus standard care (LAFA trial). BMC Surg., 6.","DOI":"10.1186\/1471-2482-6-16"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1016\/j.clnu.2012.08.013","article-title":"Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS\u00ae) Society recommendations","volume":"31","author":"Gustafsson","year":"2012","journal-title":"Clin. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1007\/s00464-012-2560-5","article-title":"Impact of a trimodal prehabilitation program on functional recovery after colorectal cancer surgery: A pilot study","volume":"27","author":"Li","year":"2013","journal-title":"Surg. Endosc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4104","DOI":"10.1007\/s00464-024-10977-7","article-title":"EAES\/SAGES evidence-based recommendations and expert consensus on optimization of perioperative care in older adults","volume":"38","author":"Keller","year":"2024","journal-title":"Surg. Endosc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1001\/jamasurg.2023.0198","article-title":"Effect of Multimodal Prehabilitation on Reducing Postoperative Complications and Enhancing Functional Capacity Following Colorectal Cancer Surgery: The PREHAB Randomized Clinical Trial","volume":"158","author":"Molenaar","year":"2023","journal-title":"JAMA Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1111\/anae.15215","article-title":"The effect of trimodal prehabilitation on the physical and psychological health of patients undergoing colorectal surgery: A randomised clinical trial","volume":"76","author":"Fulop","year":"2021","journal-title":"Anaesthesia"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1519\/JPT.0000000000000125","article-title":"Physical and Nutritional Prehabilitation in Older Patients with Colorectal Carcinoma: A Systematic Review","volume":"41","author":"Looijaard","year":"2018","journal-title":"J. Geriatr. Phys. Ther."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/j.clnu.2017.02.013","article-title":"ESPEN guideline: Clinical nutrition in surgery","volume":"36","author":"Weimann","year":"2017","journal-title":"Clin. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"106742","DOI":"10.1016\/j.ejso.2022.10.002","article-title":"ESPEN Guidelines on Clinical nutrition in surgery-Special issues to be revisited","volume":"50","author":"Weimann","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jamcollsurg.2017.11.005","article-title":"New 5-Factor Modified Frailty Index Using American College of Surgeons NSQIP Data","volume":"226","author":"Subramaniam","year":"2018","journal-title":"J. Am. Coll. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1002\/bjs.4430","article-title":"Development of a dedicated risk-adjustment scoring system for colorectal surgery (colorectal POSSUM)","volume":"91","author":"Tekkis","year":"2004","journal-title":"Br. J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"10496","DOI":"10.1038\/s41598-022-14927-y","article-title":"Psoas muscle index and psoas muscle density as predictors of mortality in patients undergoing hemodialysis","volume":"12","author":"Yajima","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"672","DOI":"10.3803\/EnM.2021.1041","article-title":"Reference Values for Skeletal Muscle Mass at the Third Lumbar Vertebral Level Measured by Computed Tomography in a Healthy Korean Population","volume":"36","author":"Yoon","year":"2021","journal-title":"Endocrinol. Metab."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"109397","DOI":"10.1016\/j.surg.2025.109397","article-title":"Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations 2025","volume":"184","author":"Gustafsson","year":"2025","journal-title":"Surgery"},{"key":"ref_21","first-page":"CD013259","article-title":"Prehabilitation versus no prehabilitation to improve functional capacity, reduce postoperative complications and improve quality of life in colorectal cancer surgery","volume":"5","author":"Molenaar","year":"2023","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1016\/j.surg.2024.07.009","article-title":"A systematic review and meta-analysis of high-quality randomized controlled trials on the role of prehabilitation programs in colorectal surgery","volume":"176","author":"Garoufalia","year":"2024","journal-title":"Surgery"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.gerinurse.2023.10.027","article-title":"Effect of prehabilitation on postoperative outcomes in the frail older people: A systematic review and meta-analysis","volume":"55","author":"She","year":"2024","journal-title":"Geriatr. Nurs."},{"key":"ref_24","first-page":"33","article-title":"Four-week prehabilitation program is sufficient to modify exercise behaviors and improve preoperative functional walking capacity in patients with colorectal cancer","volume":"25","author":"Chen","year":"2017","journal-title":"Support. Care Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"04239","DOI":"10.7189\/jogh.14.04239","article-title":"Effects of multimodal prehabilitation and exercise prehabilitation on patients undergoing colorectal surgery: A systematic review and meta-analysis of randomised controlled trials","volume":"14","author":"Zhou","year":"2024","journal-title":"J. Glob. Health"},{"key":"ref_26","first-page":"33","article-title":"Surgery of the colorectal polyps and early stage cancer-Expected standards","volume":"76","author":"Banky","year":"2023","journal-title":"Magy. Seb."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"107302","DOI":"10.1016\/j.ejso.2023.107302","article-title":"Prehabilitation in colorectal cancer surgery improves outcome and reduces hospital costs","volume":"50","author":"Sabajo","year":"2024","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_28","first-page":"D6815","article-title":"A prehabilitation program for patients undergoing elective resection of a colorectal carcinoma: Effects on the postoperative hospital stay and complication burden","volume":"166","author":"Bossema","year":"2022","journal-title":"Ned. Tijdschr. Geneeskd."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"191","DOI":"10.3393\/ac.2022.01095.0156","article-title":"Postoperative outcomes after prehabilitation for colorectal cancer patients undergoing surgery: A systematic review and meta-analysis of randomized and nonrandomized studies","volume":"40","author":"Wee","year":"2024","journal-title":"Ann. Coloproctol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e932","DOI":"10.1097\/SLA.0000000000005083","article-title":"Response to the Comment on \u201cThe Impact of Prehabilitation on Patient Outcomes in Hepatobiliary, Colorectal and Upper Gastrointestinal Cancer Surgery: A PRISMA-Accordant Meta-analysis\u201d","volume":"274","author":"Lambert","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.ijsu.2017.01.111","article-title":"A systematic review of prehabilitation programs in abdominal cancer surgery","volume":"39","author":"Hijazi","year":"2017","journal-title":"Int. J. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1080\/0284186X.2016.1267872","article-title":"Preoperative modifiable risk factors in colorectal surgery: An observational cohort study identifying the possible value of prehabilitation","volume":"56","author":"Carli","year":"2017","journal-title":"Acta Oncol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"O267","DOI":"10.1111\/codi.13429","article-title":"The effects of physical prehabilitation in elderly patients undergoing colorectal surgery: A systematic review","volume":"18","author":"Bruns","year":"2016","journal-title":"Color. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"313","DOI":"10.4174\/astr.2023.104.6.313","article-title":"Effect of prehabilitation on patients with frailty undergoing colorectal cancer surgery: A systematic review and meta-analysis","volume":"104","author":"Chang","year":"2023","journal-title":"Ann. Surg. Treat. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"106956","DOI":"10.1016\/j.ejso.2023.06.008","article-title":"Is preoperative physical function testing predictive of length of stay in patients with colorectal cancer? A retrospective study","volume":"49","author":"Carli","year":"2023","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1038\/s41440-022-01157-y","article-title":"Association between hypertension and myosteatosis evaluated by abdominal computed tomography","volume":"46","author":"Jung","year":"2023","journal-title":"Hypertens. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1007\/s10151-023-02769-3","article-title":"CT-derived measures of muscle quantity and quality predict poorer outcomes from elective colorectal surgery: A UK multicentre retrospective cohort study","volume":"27","author":"Blackwell","year":"2023","journal-title":"Tech. Coloproctol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Chang, Y.Y., and Cheng, B. (2024). Prognostic impact of myosteatosis in patients with colorectal cancer undergoing curative surgery: An updated systematic review and meta-analysis. Front. Oncol., 14.","DOI":"10.3389\/fonc.2024.1388001"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/9\/1369\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T08:16:35Z","timestamp":1777536995000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/9\/1369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,27]]},"references-count":38,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["nu18091369"],"URL":"https:\/\/doi.org\/10.3390\/nu18091369","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,27]]}}}