Esophagogastric cancer is among the most common malignancies worldwide. Surgery with or without neoadjuvant therapy is the only potentially curative treatment option. Although esophagogastric resections remain associated with major surgical trauma and significant postoperative morbidity. Prehabilitation has emerged as a novel strategy to improve clinical outcomes by optimizing physical and psychological status before major surgery through exercise and nutritional and psychological interventions.
Author; Year | Design | Description and Number of Participants; (n) | Measured Outcomes | N–O Score | Jadad Score |
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Author; Year | Prehabilitation Impact on Physical Status | Prehabilitation Impact on Postoperative Outcomes | Other Effects of Prehabilitation | |||||||||||||
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Allen et al. [19]; 2021 | Allen et al. [21]; 2021 | |||||||||||||||
Allen et al. | RCT | [19]; 2021 | Allen et al. [21]; 2021Esophagogastric cancer patients scheduled for surgery after neoadjuvant chemotherapy; ( | n | = 54) | Prehabilitation attenuated peak VO2 decrease and skeletal muscle loss following neoadjuvant therapy. Additionally, HGS was better retained in the prehabilitation group, and patients in this group were more physically active by higher weekly step count. | Prehabilitation had no impact on the number and severity of complications, length of hospital stay, 30-day readmission rates, and 3-year cancer-related mortality. | Primary outcome: |
| Secondary outcomes: |
| N/A | 3 | |||
Prehabilitation improved QoL by global health status after 2 cycles of neoadjuvant chemotherapy and at 2 weeks, 6 weeks, and 6 months postoperatively. Additionally, prehabilitation resulted in better BAI and DBI II scores preoperatively and 6 weeks and 6 months postoperatively. | A higher proportion of patients in the prehabilitation group received neoadjuvant chemotherapy at full dose. | Minnella et al. [20]; 2018 | Minnella et al. [22]; 2018 | RCT | ||||||||||||
Minnella et al. [17]; 2018 | Esophagogastric cancer patients scheduled for surgery ± neoadjuvant treatment; ( | n | = 68) | Prehabilitation improved functional capacity before and after surgery by increasing 6MWD. | Primary outcome: |
| Secondary outcomes: |
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Prehabilitation had no impact on the number and severity of complications, length of hospital stay, emergency department visits, and readmission rates. |
| N/A | 3 | ||||
N/A | Valkenet et al. [21]; 2018 | Valkenet et al. [23]; 2018 | RCT | |||||||||||||
Valkenet et al. [31]; 2018 | Valkenet et al. [18]; 2018 | Esophageal cancer patients scheduled for surgery ± neoadjuvant treatment; ( | n | = 270) | Primary outcome: |
| Secondary outcomes: |
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Prehabilitation resulted in a higher increase in inspiratory muscle strength and endurance. |
| N/A | 3 | ||||
Prehabilitation did not affect postoperative pneumonia and other postoperative complication rates. | Prehabilitation did not affect the quality of life, fatigue, and physical activity levels. | van Adrichem et al. [22]; 2014 | van Adrichem et al. [24]; 2014 | RCT | Esophageal cancer patients scheduled for surgery ± neoadjuvant CRT; ( | n | = 45) | Primary outcome: |
| Secondary outcomes: |
| N/A | 3 | |||
Xu et al. [23]; 2015 | ||||||||||||||||
van Adrichem et al. [32]; 2014 | van Adrichem et al. [19]; 2014 | The increase in maximal inspiratory pressure was similar between the groups which received preoperative inspiratory muscle training. | The incidence of postoperative pulmonary complications, length of stay, and the number of reintubations were lower in the high-intensity inspiratory muscle training group. | N/A | Xu et al. [25]; 2015 | Pilot study (RCT) | ||||||||||
Xu et al. [22]; 2015 | Xu et al. [ | Esophageal cancer patients scheduled for neoadjuvant CRT and surgery; ( | n | = 59) | 24]; 2015 | Primary outcomes: |
| Secondary outcome: |
| N/A | Prehabilitation ameliorated decline in 6MWD and hand-grip strength.3 | |||||
N/A | Prehabilitation ameliorated weight and lean muscle mass loss. | Additionally, patients in the prehabilitation group had a significantly lower need for intravenous nutritional support and wheelchair use. | Yamana et al. [24]; 2015 | Yamana et al. [26]; 2015 | RCT | Esophageal cancer patients scheduled for surgery ± neoadjuvant treatment; ( | n | |||||||||
Yamana et al. [18]; 2015 | Yamana et al. [20]; 2015 | Prehabilitation did not affect respiratory function representing parameters (FVC, FEV1, FEV1%, and PEF). = 63) | Primary outcome: |
| Secondary outcomes: |
| N/A | 3 | ||||||||
Prehabilitation ameliorated the severity of postoperative complications (by lower Clavien–Dindo score) and postoperative pneumonia (by lower Utrecht Pneumonia Scoring System score). | N/A | Christensen et al. [25]; 2018 | Christensen et al. [27]; 2018 | Non-randomized control trial | ||||||||||||
Christensen et al. [23 | Patients with GOJ adenocarcinoma scheduled for neoadjuvant treatment and surgery; ( | n | = 50) | ]; 2018 | Christensen et al. [25]; 2018 | Primary outcome: |
| Secondary outcomes: |
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Prehabilitation resulted in improved fitness and muscle strength. |
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Prehabilitation did not affect the postoperative complication rate. | 8 | N/A | ||
Prehabilitation resulted in improved quality of life by FACT-E score. | Dettling et al. [26]; 2013 | Dettling et al. [28]; 2013 | Non-randomized controlled trial | |||||||||||||
Dettling et al. [24]; 2013 | Dettling et al. [ | Patients scheduled for esophagectomy ± neoadjuvant treatment; ( | n | = 83) | 26]; 2013 | Primary outcomes: |
| Secondary outcomes: |
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Prehabilitation increased inspiratory muscle strength and endurance. |
| 8 | N/A | |||
Prehabilitation did not affect postoperative pneumonia and other complication rates. | N/A | Argudo et al. [27]; 2020 | Argudo et al. [29]; 2020 | |||||||||||||
Argudo et al. [ | Pilot study (prospective interventional study) | 19]; 2020 | Argudo et al. [Esophagogastric cancer patients scheduled for neoadjuvant treatment and surgery; ( | n | = 40) |
| 6 | N/A | ||||||||
Piraux et al. [28]; 2020 | Piraux et al. [30]; 2020 | Pilot study (prospective interventional study) | Esophagogastric cancer patients scheduled for surgery ± neoadjuvant treatment; ( | n | = 23) | Primary outcome |
| Secondary outcomes |
| 6 | N/A | |||||
Yamamoto et al. [29]; 2016 | Yamamoto et al. [31]; 2016 | Pilot study (prospective interventional study) | Gastric cancer patients aged ≥ 65 years with a diagnosis of sarcopenia scheduled for gastrectomy; ( | n | = 22) |
| 6 | N/A | ||||||||
Cho et al. [30]; 2014 | Cho et al. [32]; 2014 | Matched pair analysis | Patients with clinical stage I gastric cancer and metabolic syndrome scheduled for gastrectomy; ( | n | = 72) | Primary outcome: |
| Secondary outcomes: |
| 7 | N/A |
Author; Year | Prehabilitation Group | Control Group | |||||||||||
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Type of Prehabilitation (Unimodal vs. Multimodal) | Timing of Prehabilitation | Interventions Used for Prehabilitation | |||||||||||
Allen et al. [19]; 2021 | Allen et al. [21]; 2021 | Multimodal | Prehabilitation was initiated for 15 preoperative weeks. |
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Minnella et al. [17]; 2018 | Multimodal | Prehabilitation was initiated before the initial surgery or at the time of neoadjuvant therapy. |
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Valkenet et al. [31]; 2018 | Valkenet et al. [18]; 2018 | Unimodal | Prehabilitation was initiated for 2 weeks or longer. When neoadjuvant therapy was administered, prehabilitation started afterward. |
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van Adrichem et al. [32]; 2014 | van Adrichem et al. [19]; 2014 | Unimodal | Prehabilitation was initiated for 3 weeks. When neoadjuvant therapy was administered, prehabilitation started afterward. |
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Xu et al. [22]; 2015 | Xu et al. [24]; 2015 | Multimodal | Prehabilitation was initiated for 4–5 weeks during the neoadjuvant chemoradiotherapy. |
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Yamana et al. [18]; 2015 | Yamana et al. [20]; 2015 | Unimodal | Prehabilitation was initiated for ≥7 days before the surgery. |
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Christensen et al. [23]; 2018 | Christensen et al. [25]; 2018 | Unimodal | Prehabilitation was initiated at the time of neoadjuvant treatment. |
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Dettling et al. [24]; 2013 | Dettling et al. [26]; 2013 | Unimodal | Prehabilitation was initiated for 2 weeks or longer. |
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Argudo et al. [19]; 2020 | Argudo et al. [21]; 2020 | 21Multimodal | ]; 2020Prehabilitation was initiated after neoadjuvant chemotherapy for 5 weeks. | Prehabilitation improved exercise capacity in terms of VO2 peak and workload and distance improvement in the 6MWD and inspiratory and expiratory muscle strength. | N/A |
| Prehabilitation resulted in the improvement of some domains of health-related quality of life (social and role functions). |
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Piraux et al. [20]; 2020 | Piraux et al. [22]; 2020 | Unimodal | Prehabilitation was initiated for 2–4 weeks before the surgery. | ||||||||||
Piraux et al. [20]; 2020 | Piraux et al. [22]; 2020 | N/A |
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N/A | Prehabilitation improved fatigue, quality of life, physical well-being, emotional well-being, and anxiety. | Yamamoto et al. [21]; 2016 | Yamamoto et al. [23]; 2016 | Multimodal | Prehabilitation was initiated for 3 weeks, although the actual duration differed depending on the surgery date. | ||||||||
Yamamoto et al. [21]; 2016 | Yamamoto et al. [23]; 2016 |
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Prehabilitation significantly increased handgrip strength. | |||||||||
N/A | Prehabilitation improved nutritional uptake by increasing calorie and protein intake. | Cho et al. [25]; 2014 | Cho et al. [27]; 2014 | Unimodal | Prehabilitation was initiated for 4 weeks. |
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Cho et al. | |
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Cho et al. [ | |
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Prehabilitation decreased hospital stay and the number of severe postoperative complications (anastomotic leakage, pancreatic fistula, intra-abdominal abscess, and other severe abdominal complications). | Prehabilitation significantly decreased BMI, bodyweight, abdominal circumference, and visceral fat. |