Abstract
BackgroundPatients 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. MethodsBetween 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. ResultsSeventy-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. ConclusionPrehabilitation 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.
Highlights
All patients referred to the oesophago-gastric multidisciplinary team, aged ≥ 18 years, and with a diagnosis of potentially resectable oesophageal cancer were invited to participate in the PREPARE for Surgery programme
This study has found a significantly lower incidence of postoperative pneumonia and a shorter length of stay in patients who have undergone the PREPARE for Surgery programme in comparison to controls
Patients undergoing an oesophagectomy are at high-risk of respiratory complications
Summary
Patients undergoing oesophageal cancer surgery are often elderly, frail, malnourished, with poor functional reserve, all of which are associated with poor postoperative outcomes.[1,2,3,4] Up to 60% of patients experience post-operative complications.[5]The high morbidity can lead to a prolonged hospital stay, delayed recovery, long-term disability, and poor survival.[6,7,8].Prehabilitation utilises the time before surgery to improve a patient’s functional capacity to better withstand the stress of surgery.[9,10] Through activation of inflammatory, endocrine, and immunological responses, the ‘surgical stress response’ creates increased metabolic demand and a pro-catabolic state. 11 The introduction of neoadjuvant chemotherapy provides a survival benefit but at a cost to functional capacity when it is most needed; immediately prior to surgery.[12,13,14] This physical deconditioning represents a clear mismatch with the metabolic demand being placed on the body during and after an oesophagectomy. Patients undergoing oesophageal cancer surgery are often elderly, frail, malnourished, with poor functional reserve, all of which are associated with poor postoperative outcomes.[1,2,3,4] Up to 60% of patients experience post-operative complications.[5]. Patients undergoing oesophageal cancer surgery are often frail with a high risk of post-operative complications. 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). There was no significant difference in the incidence of overall complications or severe complications
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