Published online Nov 27, 2026. doi: 10.4240/wjgs.124456
Revised: August 24, 2026
Accepted: October 10, 2026
Published online: November 27, 2026
Processing time: 113 Days and 20.6 Hours
The incidence of postoperative frailty is elevated among patients undergoing laparoscopic colorectal cancer surgery. However, enhanced recovery after surgery (ERAS)-based preoperative interventions are frequently limited to health education and dietary advice, and adherence to prehabilitation protocols is poor, creating a need for structured and quantifiable perioperative intervention strategies.
To evaluate the effect of an ERAS-based preoperative prehabilitation management model, delivered through a mobile application, on postoperative frailty and func
This was a single-center, two-arm, parallel-group, assessor-blinded, superiority randomized controlled trial with a 1:1 allocation ratio. A total of 182 patients with colorectal cancer admitted to our hospital between October 2023 and October 2025 were enrolled and randomly assigned to a control group and an experimental group (n = 91 each) using a random number table. The control group received conventional ERAS perioperative management, whereas the experimental group received an ERAS-based preoperative prehabilitation management model combining structured exercise training, nutritional support, psychological intervention, and remote monitoring via a mobile application from admission until the day before surgery (≥ 14 days). The prespecified primary outcome was the incidence of postoperative frailty at 6 months after surgery. Secondary outcomes included Fried frailty scores, gastrointestinal recovery, mobility, inflammatory markers, quality of life, and postoperative complications.
All 182 randomized patients completed the study and were analyzed. At 1 month, 3 months, and 6 months postoperatively, Fried scores were lower in the experimental group than in the control group (P < 0.05). The incidence of frailty at 6 months postoperatively was 9.89% (9/91) in the experimental group vs 20.88% (19/91) in the control group [relative risk (RR): 0.47, 95% confidence interval (CI): 0.23-0.99; risk difference (RD): -11.0%, 95%CI: -21.4% to -0.6%]. In the experimental group, the time to return of bowel sounds [mean difference (MD): -4.49 hours, 95%CI: -6.30 to -2.68], time to first flatus (MD: -3.66 hours, 95%CI: -6.23 to -1.09), time to first bowel movement (MD: -3.51 hours, 95%CI: -5.93 to -1.09), time to first oral intake (MD: -4.07 hours, 95%CI: -6.91 to -1.22), and postoperative length of hospital stay (MD: -1.50 days, 95%CI: -2.13 to -0.87) were all shorter than in the control group (P < 0.05). At 1 month and 6 months postoperatively, the experimental group's 6-minute walk test and Berg Balance Scale scores were higher than those of the control group (P < 0.05). At 7 days postoperatively, serum interleukin-6, tumor necrosis factor-α, and interferon-γ levels were lower in the experimental group than in the control group (P < 0.05). At 6 months postoperatively, scores for all dimensions of the Functional Assessment of Cancer Therapy-Colorectal were higher in the experimental group (P < 0.05). The incidence of postoperative complications was 2.20% (2/91) in the experimental group vs 9.89% (9/91) in the control group (RR: 0.22, 95%CI: 0.05-1.00; Fisher's exact P = 0.058; χ2 test P = 0.029).
In this single-center randomized trial, an ERAS-based preoperative prehabilitation management model was associated with less postoperative frailty, faster gastrointestinal and motor recovery, attenuated inflammatory responses, and better quality of life after laparoscopic colorectal cancer surgery. These findings require confirmation in prospectively registered, multicenter trials with longer follow-up before broader implementation can be recommended.
Core Tip: This study focuses on patients undergoing laparoscopic colorectal cancer surgery, establishing a preoperative prehabilitation model centered on exercise and facilitated by a mobile application, with conventional enhanced recovery after surgery (ERAS) management serving as the control. The study specifically examines the impact of this model on the incidence of frailty, recovery of gastrointestinal function, physical performance, inflammatory markers, quality of life, and complications at 1 month, 3 months, and 6 months post-surgery. Through multidimensional quantitative interventions and comprehensive remote monitoring, the study aims to clarify the efficacy and mechanisms of the prehabilitation model, with the goal of optimizing ERAS perioperative management, addressing limitations in traditional interventions, and providing an evidence-based foundation for clinical rehabilitation.