What are the impact and the optimal design of a physical prehabilitation program in patients with esophagogastric cancer awaiting surgery? A systematic review

Abstract

Background Substantial postoperative complications occur after tumor resection for esophagogastric cancers. Physical prehabilitation programs aim to prepare patients for surgery by improving their functional status with the aim of reducing postoperative complications. This systematic review aims to summarize the effects of physical prehabilitation programs on exercise capacity, muscle strength, respiratory muscle function, postoperative outcomes, and health-related quality of life and to determine the optimal design of such a program to improve these outcomes in esophagogastric cancer patients undergoing tumor resection. Methods A systematic literature review was conducted using PubMed, The Cochrane Library, Scopus, and PEDro databases to identify studies evaluating the effects of physical prehabilitation program on exercise capacity, muscle strength, respiratory muscle function, postoperative complications, length of hospital stay, mortality, and health-related quality of life in patients with esophagogastric cancer awaiting surgery. Data from all studies meeting the inclusion criteria were extracted. The quality of each selected study was determined using the Downs and Black checklist. Results Seven studies with 645 participants were included. The preoperative exercise program consisted of respiratory training alone in three studies, a combination of aerobic and resistance training in two studies, and a combination of respiratory, aerobic, and resistance training in two studies. Training frequency ranged from three times a day to twice a week and each session lasted between 20 and 75 min. Four studies were of fair quality and three of good quality. Some studies reported improvements in maximal inspiratory pressure, inspiratory muscle endurance, postoperative (pulmonary) complications, and length of hospital stay in the preoperative exercise group compared to the control group. Conclusion This systematic review reports the current evidence for physical prehabilitation programs in patients with esophagogastric cancer awaiting surgery. However, due to the limited number of randomized controlled trials, the significant heterogeneity of exercise programs, and the questionable quality of the studies, higher quality randomized controlled trials are needed. Trial registration PROSPERO Registration Number: CRD42020176353.

A toolbox for a structured risk-based prehabilitation program in major surgical oncology

“…The literature research revealed 24 out of 55 studies with Oxford evidence levels of 1 and 2 focusing on prehabilitation prior to intra-abdominal or thoracic surgery predominantly in the oncologic area and including 353,014 patients for analysis ( 27 , 29 – 32 , 34 , 36 – 39 , 43 , 48 , 49 , 51 , 52 , 55 , 56 , 58 , 60 , 65 , 68 , 69 , 72 ). One guideline was related to the general population with recommendations for physical activity ( 22 ).…”

“…A total of 18 (78%) studies investigated different types of exercise interventions and exercise testing. Thirteen studies applied inspiratory muscle training (IMT) to prepare patients for surgery ( 30 , 32 , 36 , 43 , 48 , 49 , 52 , 55 , 58 , 60 , 68 , 69 , 72 ). Five studies reported high intense interval training (HIIT) as modality ( 27 , 29 , 34 , 60 , 68 ), and in five studies, the intensity was controlled with various target measurements of intensity ( 27 , 29 , 55 , 56 , 72 ).…”

“…Thirteen studies applied inspiratory muscle training (IMT) to prepare patients for surgery ( 30 , 32 , 36 , 43 , 48 , 49 , 52 , 55 , 58 , 60 , 68 , 69 , 72 ). Five studies reported high intense interval training (HIIT) as modality ( 27 , 29 , 34 , 60 , 68 ), and in five studies, the intensity was controlled with various target measurements of intensity ( 27 , 29 , 55 , 56 , 72 ). Two interventions were performed as purely home based ( 55 , 68 ); all other trials were carried out as hybrid trials, and only five trials offered individualized exercising programs tailored to each patient ( 27 , 29 , 49 , 56 , 68 ).…”

Comparison of Shear Wave Elastography and Dynamometer Test in Muscle Tissue Characterization for Potential Medical and Sport Application

“…Qualitative and quantitative skeletal muscle assessment demonstrated independent associations with fitness and clinical outcomes among cancer survivors (50,51). For example, physical prehabilitation programs could prepare patients for surgery by improving their functional status with the aim of reducing postoperative complications (52,53). The number of cancer survivors with less complications is continuously increasing due to improved screening, diagnoses, imaging, endoscopic-, histopathologic and molecular examination methods, and interdisciplinary defined treatments using advanced technology in local therapeutic modalities and effective novel approaches such as molecular targeted systemic therapy and immunotherapy and their combination.…”

Frailty, Meeting Challenges, and Beyond in Geriatric Surgery—10 Years' Experience From Singapore's First Geriatric Surgical Service

“…Furthermore, it is also anticipated to bring about changes in the lifestyle behavior of the older patients postsurgery, facilitating their return to premorbid function and maintaining a healthy lifestyle 41. It has been shown that preoperative physical programs are feasible and safe and may be beneficial for improving exercise capacity, muscle strength, respiratory muscle function, health-related quality of life, postoperative complications, and length of stay in the surgical older population 42. A combination of resistance, aerobic, balance, and flexibility exercises is encouraged to provide comprehensive training for the older adults.…”