Abstract: Objective: To investigate the impact of multimodal prehabilitation on the stress response, intestinal function and nutritional status in elderly patients after colorectal cancer surgery. Methods: A randomized controlled trial was conducted, enrolling 192 elderly patients with colorectal cancer admitted to the Department of Colorectal and Anorectal Surgery at the First Affiliated Hospital of Guangxi Medical University from April 2023 to May 2024. They were randomly divided into the experimental group and the control group, with 96 patients in each group, using the random number table method. The control group received standard care, while the experimental group underwent multimodal prehabilitation. The stress responses, postoperative intestinal function recovery, psychological states and nutritional status of the two groups of patients were compared. Results: The time of first flatus passage and the time of first defecation in the experimental group were shorter than those in the control group (both P＜0.05). Through repeated-measures analysis of variance, the main effects of heart rate, systolic blood pressure, and diastolic blood pressure in both groups of patients due to the time factor and the group factor, as well as the interaction effect of time×group, were statistically significant (all P＜0.05). There was a statistically significant difference in the main effect of serum albumin time in both groups (F=60.763, P＜0.001), while the main effect of group (F=0.444, P=0.506), and the interaction effect of time×group (F=0.422, P=0.725) were not statistically significant. The hospital anxiety and depression scale-anxiety subscale (HADS-A) scores of the experimental group on postoperative day 3 were lower than those of the control group (P=0.003). The incidence of postoperative complications in the experimental group and the control group was 9.38% and 12.50% respectively, and there was no statistically significant difference between the two groups (χ²=0.481, P=0.488). Conclusion: Multimodal prerehabilitation can promote the recovery of intestinal function in elderly patients with colorectal cancer after surgery, stabilize physiological indicators, and alleviate postoperative psychological anxiety. However, its underlying mechanism related to nutritional status needs further investigation.