Annals of Coloproctology

Reviews

Colorectal cancer

Postoperative outcomes after prehabilitation for colorectal cancer patients undergoing surgery: a systematic review and meta-analysis of randomized and nonrandomized studies: Ian Jun Yan Wee, Isaac Seow-En, Aik Yong Chok, Eileen Sim, Chee Hoe Koo, Wenjie Lin, Chang Meihuan, Emile Kwong-Wei Tan; Ann Coloproctol. 2024;40(3):191-199. Published online May 16, 2024; DOI: https://doi.org/10.3393/ac.2022.01095.0156

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Purpose
Prehabilitation (PH) is purported to improve patients’ preoperative functional status. This systematic review and meta-analysis sought to compare short-term postoperative outcomes between patients who underwent a protocolized PH program and the existing standard of care among colorectal cancer patients awaiting surgery.
Methods
A search in MEDLINE/PubMed, the Cochrane Library, Embase, Scopus, and CINAHL was conducted to identify relevant articles. Repetitive and exhaustive combinations of MeSH search terms (“prehabilitation,” “colorectal cancer,” “colon cancer,” and “rectal cancer”) were used to identify randomized and nonrandomized studies comparing PH versus standard of care for colorectal cancer patients awaiting surgery. The primary outcomes included postoperative morbidity, length of hospital stay, and readmission rates.
Results
Seven studies including 1,042 colorectal cancer patients (PH, 382) were included. No significant differences were found in intraoperative outcomes. The postoperative complication rates were comparable between groups (Clavien-Dindo grades I and II: risk ratio, 0.82; 95% confidence interval, 0.62–1.07; P=0.15; Clavien-Dindo grades ≥III: risk ratio, 1.02; 95% confidence interval, 0.72–1.44; P=0.92). There were also no significant differences in length of hospital stay (P=0.21) or the risk of 30-day readmission (P=0.68).
Conclusion
Although PH does not appear to improve short-term postoperative outcomes following colorectal cancer surgery, the quality of evidence is impaired by the limited trials and heterogeneity. Thus, further large-scale trials are warranted to draw definitive conclusions and establish the long-term effects of PH.

Citations

Citations to this article as recorded by

The inequalities and challenges of prehabilitation before cancer surgery: a narrative review
Hilary Stewart, Sophie Stanley, Xiubin Zhang, Lisa Ashmore, Christopher Gaffney, Jo Rycroft‐Malone, Andrew F. Smith, Laura Wareing, Cliff Shelton
Anaesthesia.2025; 80(S2): 75. CrossRef
Prehabilitation in surgery – an update with a focus on nutrition
Chelsia Gillis, Arved Weimann
Current Opinion in Clinical Nutrition & Metabolic Care.2025; 28(3): 224. CrossRef
The role of exercise-based prehabilitation in enhancing surgical outcomes for patients with digestive system cancers: a meta-analysis
Shasha Xu, Rong Yin, Haiou Zhu, Yin Gong, Jing Zhu, Changxian Li, Qin Xu
BMC Gastroenterology.2025;[Epub] CrossRef
Identifying and optimizing psychosocial frailty in surgical practice
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Seminars in Colon and Rectal Surgery.2024; 35(4): 101061. CrossRef

Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis: Ian Jun Yan Wee, Chee Hoe Koo, Isaac Seow-En, Yvonne Ying Ru Ng, Wenjie Lin, Emile John Kwong-Wei Tan; Ann Coloproctol. 2023;39(1):3-10. Published online January 3, 2023; DOI: https://doi.org/10.3393/ac.2022.00598.0085

7,460 View
404 Download
14 Web of Science
20 Citations

Abstract PDF Supplementary Material

Purpose
This study compared the short- and long-term clinical outcomes of laser hemorrhoidoplasty (LH) vs. conventional hemorrhoidectomy (CH) in patients with grade II/III hemorrhoids.
Methods
PubMed/Medline and the Cochrane Library were searched for randomized and nonrandomized studies comparing LH against CH in grade II/III hemorrhoids. The primary outcomes included postoperative use of analgesia, postoperative morbidity (bleeding, urinary retention, pain, thrombosis), and time of return to work/daily activities.
Results
Nine studies totaling 661 patients (LH, 336 and CH, 325) were included. The LH group had shorter operative time (P<0.001) and less intraoperative blood loss (P<0.001). Postoperative pain was lower in the LH group, with lower postoperative day 1 (mean difference [MD], –2.09; 95% confidence interval [CI], –3.44 to –0.75; P=0.002) and postoperative day 7 (MD, –3.94; 95% CI, –6.36 to –1.52; P=0.001) visual analogue scores and use of analgesia (risk ratio [RR], 0.59; 95% CI, 0.42–0.81; P=0.001). The risk of postoperative bleeding was also lower in the LH group (RR, 0.18; 95% CI, 0.12– 0.28; P<0.001), with a quicker return to work or daily activities (P=0.002). The 12-month risks of bleeding (P>0.999) and prolapse (P=0.240), and the likelihood of complete resolution at 12 months, were similar (P=0.240).
Conclusion
LH offers more favorable short-term clinical outcomes than CH, with reduced morbidity and pain and earlier return to work or daily activities. Medium-term symptom recurrence at 12 months was similar. Our results should be verified in future well-designed trials with larger samples.

Citations

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Best clinical practice recommendations for the management of symptomatic hemorrhoids via laser hemorrhoidoplasty: the LHP recommendations
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Quality of Life of Patients Before and After Hemorrhoid Surgery: A Single-Center Study in Vietnam
Nguyen Thi Thuy Anh, Nguyen Ngoc Huynh Nhu, Tran Ngoc Hong, Pham Thi Ly, Nguyen Thi Hong Huyen, Doan Thi Minh, Ho Tat Bang, Nguyen Trung Tin
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Minimally invasive laser technologies in the surgical treatment of hemorrhoidal disease: problems and prospects (literature review)
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Comments on “Laser hemorrhoidoplasty versus conventional hemorrhoidectomy for grade II/III hemorrhoids: a systematic review and meta-analysis”
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Annals of Coloproctology.2023; 39(5): 442. CrossRef

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