Prehabilitation during oesophageal cancer neoadjuvant chemotherapy and postoperative functional exercise capacity.

OBJECTIVE

To investigate whether initiating prehabilitation during neoadjuvant chemotherapy (NAC) is associated with postoperative recovery of functional exercise capacity in patients with oesophageal cancer.

METHODS

In this multicentre observational study, we classified patients with oesophageal cancer into two groups based on the timing of prehabilitation: the early prehab (initiated during NAC) and late prehab (initiated after NAC) groups. Prehabilitation consisted mainly of an exercise programme combining supervised sessions with prescribed self-exercise. Functional exercise capacity was assessed using the 6 min walk distance (6MWD) before surgery (T0) and at 3 (T1) and 6 weeks (T2) postoperatively. Secondary outcomes included muscle strength, body weight, fatigue and health-related quality of life. Between-group differences in changes in 6MWD were analysed using a linear mixed-effects model, and secondary outcomes were descriptively summarised.

RESULTS

51 patients were analysed (early prehab group, n=17; late prehab group, n=34). Both groups showed a decline in 6MWD at T1 with partial recovery at T2. The early prehab group showed a smaller decrease in 6MWD at T2 (-13 m) compared with the late prehab group (-27 m), though the difference was not statistically significant (p=0.70). Trends favoured the early prehab group in muscle strength, fatigue and global health status scores.

CONCLUSIONS

This study observed a modest trend towards better postoperative recovery in patients who initiated prehabilitation during NAC, although no statistically significant differences were detected between groups. Further prospective trials are needed to refine intervention quality and identify patient populations most likely to benefit.

TRIAL REGISTRATION NUMBER: UMIN000047895.