The Impact of Prehabilitation on Post-operative Outcomes in Oesophageal Cancer Surgery: a Propensity Score Matched Comparison

Abstract

Background Patients undergoing oesophageal cancer surgery are often frail with a high risk of post-operative complications. Prehabilitation has been shown to reduce post-operative complications in specific patient populations but evidence in oesophageal cancer patients is inconclusive. Methods Between January 2016 and April 2019, all patients with resectable oesophageal cancer who underwent curative treatment at a specialist tertiary centre participated in a personalised, home-based, multimodal prehabilitation programme. Post-operative complications and hospital stay in this group were compared to a control sample. Propensity score matching was used to control for differences in baseline characteristics. Results Seventy-two patients who completed prehabilitation and 39 control patients were studied; following propensity score matching, there were 38 subjects in each group. In comparison to matched controls, patients in the prehabilitation group had a lower incidence of post-operative pneumonia (prehabilitation = 26%; control = 66%; p = 0.001) and a shorter length of stay (prehabilitation = median 10 days, IQR 8–17 days; control = median 13 days, IQR 11–20 days; p = 0.018). On multivariate regression analysis, participation in prehabilitation was associated with a 77% lower incidence of post-operative pneumonia (OR 0.23, 95% CI 0.09 to 0.55 p = 0.001). There was no significant difference in the incidence of overall complications or severe complications. Conclusion Prehabilitation was associated with a lower incidence of post-operative pneumonia and shorter hospital length of stay following oesophagectomy. This model of home based, personalised, and supervised prehabilitation is effective and relevant to centralised cancer services.

Evaluation of the Structure and Health Impacts of Exercise-Based Cardiac and Pulmonary Rehabilitation and Prehabilitation for Individuals With Cancer: A Systematic Review and Meta-Analysis

“…Figure 1 shows the PRISMA diagram with exclusion reasons. In total these 36 manuscripts described 33 unique programs; three programs were described in 2–3 different manuscripts ( 26 , 27 , 32 , 33 , 38 , 39 , 47 , 52 ), two manuscripts described 2 or 3 unique programs ( 22 , 31 ).…”

Physiotherapy Regimens in Esophagectomy and Gastrectomy: a Systematic Review and Meta-Analysis

“…Among the studies assessing prehabilitation, seven were RCTs [38][39][40][41][42][43][44] with an intervention group and a comparative control group, while one RCT 45 compared two different types of interventions; the remaining nine publications were cohort studies. 2,[46][47][48][49][50][51][52][53] For the studies assessing periand postoperative physiotherapy, there were six RCTs [54][55][56][57][58][59] comparing an intervention with a control group, and one study 60 compared two different types of physiotherapy. Among the cohort studies, eight studies [61][62][63][64][65][66][67][68] S5.…”

A qualitative study exploring patient's experiences of oesophageal cancer surgery, through their personal advice to future patients

“…Many former patients had themselves experienced advantages of being physically active in the perioperative phase. The overall positive health effects of physical activity are well established in the general population (Bull, 2020), for cancer patients overall (Fong, H. 2012;Rock et al, 2012) and prehabilitation including exercise has improved perioperative functional capacity and shortened length of hospital stay in patients receiving oesophageal J o u r n a l P r e -p r o o f cancer surgery (Minnella et al, 2018;Halliday et al, 2020). However, such advice may carry more weight coming from peers than from health care staff, and can perhaps reach broader if the information can be accessed from different sources concurrently.…”