Impact of curative treatment on the physical fitness of patients with esophageal cancer: A systematic review and meta-analysis

Abstract

Background: Esophageal cancer and curative treatment have a significant impact on the physical fitness of patients. Knowledge about the course of physical fitness during neoadjuvant therapy and esophagectomy is helpful to determine the needs for interventions during and after curative treatment. This study aims to review the current evidence on the impact of curative treatment on the physical fitness of patients with esophageal cancer. Methods: A systematic literature search of PubMed, Embase, Cinahl and the Cochrane Library was conducted up to March 29, 2021. We included observational studies investigating the change of physical fitness (including exercise capacity, muscle strength, physical activity and activities of daily living) from pre-to post-neoadjuvant therapy and/or from pre-to post-esophagectomy. Quality of the studies was assessed and a meta-analysis was performed using standardized mean differences. Results: Twenty-seven articles were included. After neoadjuvant therapy, physical fitness decreased significantly. In the first three months after surgery, physical fitness was also significantly decreased compared to preoperative values. Subgroup analysis showed a restore in exercise capacity three months after surgery in patients who followed an exercise program. Six months after surgery, there was limited evidence that exercise capacity restored to preoperative values. Conclusion: Curative treatment seems to result in a decrease of physical fitness in patients with esophageal cancer, up to three months postoperatively. Six months postoperatively, results were conflicting. In patients who followed a pre-or postoperative exercise program, the postoperative impact of curative treatment seems to be less.

State of the art of enhanced recovery after surgery (ERAS) protocols in esophagogastric cancer surgery: the Western experience

“…Markar et al [13]showed that the knowledge and experience gained by the staff in the ERAS protocol is associated with a significant reduction in median LOS.Patients' engagementis also fundamentalto facilitate the compliance of ERAS protocols [63].Finally, continuous data evaluation with systematic audits is crucial to improve compliance and clinical outcomes [15,63] With the aim to optimize functional capacity prior to surgery, the concept ofprehabilitationemergedin recent years and is being considered as key component of ERAS programs. Prehabilitationcomprises nutritional assessment, psychological counselling, medical optimization, and a structured exercise program involving both aerobic and strengthening activity, using thetime between diagnosis and surgery [65,66].Recent systematic reviews have shown that the implementation of exercise intervention improves the post-operative physical fitnessreducing postoperative morbidity (especially post-operative pneumonia) rates [67,68].…”

Adequate Management of Postoperative Complications after Esophagectomy: A Cornerstone for a Positive Outcome

“…The patient’s co-morbidities play an important role, with the most negatively influential being heart and lung diseases [ 5 ], diabetes [ 6 ], morbid obesity [ 7 ], associated malnutrition [ 8 ], and smoking [ 9 ]. A new systematic review and meta-analysis of the preoperative physical fitness of patients showed that an unfit status was associated with a higher risk of postoperative morbidity and mortality in patients with esophageal cancer [ 10 ]. Recent reviews of postoperative complication management suggested that the surgical team should have a low threshold for scrutinizing their occurrence [ 11 , 12 , 13 ].…”