Prehabilitation for esophagectomy

Abstract

Esophagectomy remains the mainstay treatment of esophageal cancer (EC). Combined with neoadjuvant therapies, the management of EC has deleterious effects on body composition, functional capacity and psychological well-being. Preoperative patient optimisation known as prehabilitation is a novel intervention aimed at reducing morbidity and mortality associated with the trajectory of EC care. There is emerging evidence to suggest that prehabilitation is safe, feasible and efficacious. In addition, there is strong data to infer that prehabilitation has a positive effect on functional capacity through exercise. Nutritional and psychological interventions are less well evaluated. Furthermore, no convincing relationship between prehabilitation and oncological outcomes has been demonstrated. Early studies evaluating prehabilitation are promising however further large scale research is required in order to assess the clinical effectiveness.

Oesophageal cancer: The effect of early nutrition support on clinical outcomes

“…It should also be considered whether early nutrition support may also help to prevent such significant pre-operative Early nutrition support in addition to exercise and psychological support in the form of a multimodal prehabilitation programme may be effective at improving post-operative outcomes, which has already been proven in colorectal cancer [34]. Results to date specifically related to oesophageal cancer are heterogeneous mainly due to the majority studies to date being on mixed cohorts of GI cancer and wide variation in the design of prehab programmes, for example unimodal or multimodal [35,36]. Several studies are currently underway examining the effect of prehabilitation in oesophageal cancer specifically and the results of these are eagerly anticipated and may help to add to the current evidence base for the use of early nutrition support within this setting [37,38].…”

Root causes and outcomes of postoperative pulmonary complications after abdominal surgery: a retrospective observational cohort study

“…The improvement of physical capacity through prehabilitation may facilitate better recovery after surgery and the current evidence is that prehabilitation protocols and optimization of preoperative care, in particular, respiratory function, may reduce PPCs incidence and mortality [40–42]. In this sense, it is important to study more comprehensive preoperative risk scores such as P-Possum and ACS NSIQ Risk Calculator to better identify risk patients [43–48].…”

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

“…Observational studies including other interventions (e.g. physiotherapeutic and/or dietetic interventions) as part of usual care treatment were not excluded, since the implementation of interventions aimed to improve or preserve physical fitness are more and more implemented in usual care treatment for patients with esophageal cancer [20,21].…”

“…In addition, a decline in physical fitness may have a negative impact on health related quality of life for cancer survivors [18,19]. Accordingly, to optimize patient outcomes, an important aim of esophageal cancer treatment is to preserve or restore the physical fitness of patients [20,21]. To achieve an optimal physical fitness, knowledge about the course of physical fitness during the treatment pathway is essential.…”