Preoperative Short-Term Nutrition and Exercise Trial Program for Patients with Esophageal Cancer: A Randomized Clinical Trial: Thoracic Oncology.

Abstract

Esophagectomy confers high postoperative morbidity and mortality. To improve postoperative outcomes, this study investigated the effectiveness of a 2-week prehabilitation program on the preoperative cardiopulmonary function of patients undergoing surgery for esophageal cancer. In this parallel-group, open-label, superiority randomized clinical trial, participants were randomly assigned (1:1) to the multimodal prehabilitation (m-prehab) group or the control group and received exercise instruction from a physical therapist. The m-prehab group received additional exercise instruction 1 week later and were administered additional oral nutritional supplements (430 kcal and 47 g protein 2 weeks before surgery). The primary outcome was change in the anaerobic threshold (AT) from baseline to immediately before surgery. Among the participants (42 men and 8 women; m-prehab [n = 25], control [n = 24]; mean age, 65.3 years), those in the m-prehab group consumed significantly more protein than those in the control group (76.8 ± 16.6 vs 61.6 ± 18.0 g/day, p < 0.01). The m-prehab and control groups showed no significant intergroup difference in preoperative daily step counts (7590 and 7910, respectively) or change in AT. Quadriceps strength increased significantly more in the m-prehab group than in the control group (3.7 ± 13.5 vs - 5.3 ± 16.0; p = 0.04), and the skeletal muscle index showed a nonsignificant but increasing trend (4.0 ± 6.5 vs 1.1 ± 4.8; p = 0.09). Estimated protein intake was unassociated, whereas preoperative step count was significantly correlated positively with change in AT (r = 0.412; p = 0.02). This prehabilitation program increased preoperative protein intake but did not contribute to an increase in physical activity, nor did it result in significant differences in preoperative changes in AT. Trial Registration Japan Registry of Clinical Trials, Number: jRCTs041190075 ( https://jrct.niph.go.jp/en-latest-detail/jRCTs041190075 ).