Prehabilitation Versus Enhanced Recovery Program for Elective Colorectal Cancer Surgery.

Aim: Colorectal cancer patients with a planned resection are tested if a complex, trimodal rehabilitation program can hold functional and morbidity benefit for them. In the prospective, randomized (1:1) study control patient group will be the well established and tested ERAS (enhanced recovery after surgery) Program. Study protocol in details: 1. First visit: Outpatient Department of Surgery On both arms: • History taking (including family history and oncologic history); • Physical examination * Operation indication, type of procedure and date of procedure agreed; * Organizing further investigations, anesthesia; * Operative risk assessment ("ACS - surgical risk calculator"); * Study patient identifier Nr generated; 2. Nurse-led ERAS/Prehab clinic: randomization On both arms: • Randomization (Prehabilitation Program / ERAS Program). • Nurse led clinic assessment ("study nurse"): .i. CaseReportForm (CRF) filled in. .ii. Patient data (personal data, demographics, history) .iii. Anthropometrics (BMI, MUST, Body fat % measurement). .iv. Mental hygienic status assessment (smoking, alcohol consumption, anxiety, depression, sleeping disorders). .v. Cardiovascular status (resting HR, RR). .vi. Operative risk assessment (CR-Possum score). .vii. Preoperative counseling (operation type, preparation, pain management, discharge plan). .viii. Preoperative nutritional planning (education, nutrient prescription). .ix. Alcohol intake and smoking cessation - information given. .x. Stoma education started. .xi. Consent signed, patient workbook handed over. .xii. Respiratory test referral. 3. Physiotherapy, first visit Both on control and interventional arms: * Respiratory function test recorded. * Physical status tested (6MWD) on a treadmill. Just on Prehabilitation arm: • Respiratory training education. • Respiratory trainer device usage educated. • Daily activity (walking) planned. 4. Physiotherapy - second/third/fourth visit (weekly) Just on Prehabilitation arm: * Previous week activity reviewed as to workbook. * Physical assessment: 6MWD, FVC. * Next week activity planned. 5. Psychic preparation Just on Prehabilitation arm: • Once a week half an hour group relaxation training - regardless of the stage of prehabilitation program. 6. Admission to the Surgical Ward a day before surgery Both on control and interventional arm: • Preoperative assessment: .i. Anthropometrics (BMI, body fat%). .ii. Cardiovascular stage (resting HR and RR), ECG. .iii. Respiratory function tests. .iv. Physical status (6MWD) .v. Mental status (Hospital Anxiety and Depression Scale (HADS)) assessment. • Preoperative preparation (as to ERAS protocol). • Postoperative care (ITU, pain management, mobilization, oral nutrition built up, drains early removal, complications recorded (Clavien-Dindo-classification)). • Stoma education. * Dietary education. * On discharge: Quality of Life (QoL) SF36 - (36-Item Short Form Survey from the RAND Medical Outcomes Study). 7. Postoperative follow up: Both on control and interventional arms: • Assessment (4th and 8th week post op.): .i. Anthropometrics (BMI, Body fat %) .ii. Cardiovascular status (resting HR and RR). .iii. Respiratory function tests. .iv. Physical status (6MWD).