Introduction: Patients undergoing resection for colorectal liver metastases (CRLM) frequently experience postoperative functional decline, delayed recovery, and reduced tolerance to adjuvant chemotherapy. Although exercise rehabilitation benefits several cancer populations, its safety and feasibility immediately after major liver surgery have remained uncertain.
Introduction:
Patients undergoing resection for colorectal liver metastases (CRLM) frequently experience postoperative functional decline, delayed recovery, and reduced tolerance to adjuvant chemotherapy. Although exercise rehabilitation benefits several cancer populations, its safety and feasibility immediately after major liver surgery have remained uncertain. This randomized controlled trial evaluated whether structured early postoperative exercise could improve recovery without increasing postoperative harm.
Why was this study needed?
. Recovery after CRLM surgery is often prolonged and may delay adjuvant chemotherapy.
. Postoperative complications and physical deconditioning reduce quality of life and treatment tolerance.
. The safety of initiating structured exercise soon after major liver resection has not been established.
. Evidence is needed to guide postoperative rehabilitation protocols in hepatic oncology.
Results:
In this randomized trial, patients who began a supervised exercise program shortly after hospital discharge experienced no increase in serious adverse events compared with standard care, confirming the safety of early rehabilitation. Importantly, the exercise group had fewer non-serious postoperative complications, initiated adjuvant chemotherapy substantially earlier, and required fewer chemotherapy dose modifications. Participants also demonstrated significant improvements in quality of life, cardiorespiratory fitness, and physical performance, indicating that early exercise accelerated functional recovery while enhancing tolerance to postoperative systemic therapy.
Clinical Impact:
These findings support the incorporation of structured exercise into enhanced recovery pathways following CRLM resection. Early postoperative rehabilitation appears both feasible and safe, with potential benefits extending beyond physical recovery to improved delivery of adjuvant chemotherapy. Larger multicenter trials are warranted to confirm these findings and define optimal exercise protocols.
Bottom Line:
Early structured exercise after colorectal liver metastasis surgery is safe, reduces postoperative morbidity, improves functional recovery and quality of life, and facilitates earlier, better-tolerated adjuvant chemotherapy.
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