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Review
. 2024 Jul;21(3):283-297.
doi: 10.1007/s10388-024-01049-9. Epub 2024 Feb 27.

Effectiveness of prehabilitation during neoadjuvant therapy for patients with esophageal or gastroesophageal junction cancer: a systematic review

Tomohiro Ikeda  1 , Shusuke Toyama  2 , Tsuyoshi Harada  3   4 , Kazuhiro Noma  5 , Masanori Hamada  6 , Takashi Kitagawa  7
Affiliations
Review

Effectiveness of prehabilitation during neoadjuvant therapy for patients with esophageal or gastroesophageal junction cancer: a systematic review

Tomohiro Ikeda et al. Esophagus. 2024 Jul.

Abstract

Progression of the physical weakness during neoadjuvant therapy (NAT) in patients with esophageal or gastroesophageal junction cancer is a serious problem; however, prehabilitation during NAT has the potential to overcome the unmet need. Nevertheless, systematic reviews on this topic have not been summarized. Therefore, this systematic review aimed to determine prehabilitation's effectiveness, acceptability, and safety during NAT for patients with esophageal or gastroesophageal junction cancer. An electronic search was performed in the MEDLINE, Web of Science, CENTRAL, CINAHL, and PEDro databases. A meta-analysis was conducted to assess the effectiveness of prehabilitation during NAT, along with a descriptive analysis of acceptance and safety. This study analyzed data from three randomized controlled trials (RCTs) and nine non-RCTs involving 664 patients. The meta-analysis of two RCTs demonstrated that prehabilitation during NAT may be more effective than usual care in enhancing tolerance to NAT and grip strength; moreover, one RCT and three non-RCTs revealed that prehabilitation may reduce the risk of postoperative complications. The adherence rates for exercise programs in two RCTs and seven non-RCTs were 55-76%. Additionally, two studies reported a 76% adherence rate for multimodal prehabilitation programs, including exercise, dietary, and psychological care. Six studies reported no serious prehabilitation-related adverse events during NAT. Prehabilitation during NAT may be a safe and beneficial intervention strategy for patients with esophageal or gastroesophageal junction cancer. However, the investigation of strategies to enhance adherence is essential. Furthermore, additional high-quality RCTs are needed to examine the effect of prehabilitation during NAT.

Keywords: Esophageal cancer; Gastroesophageal junction cancer; Neoadjuvant therapy; Physical weakness; Prehabilitation; Systematic review.

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Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of study selection. This flow diagram demonstrates the study screening and selection process. PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Fig. 2
Fig. 2
Results of bias risk assessment of RCTs using RoB 2. The risk of bias in randomized controlled trials (RCTs) is assessed using risk of bias 2 (RoB2) at three levels: low, some concerns, and high
Fig. 3
Fig. 3
Effect of prehabilitation during NAT on exercise capacity. Forest plot shows effect on exercise capacity after NAT. Forest plot using only randomized controlled trials. Std. standard; 95% CI 95% confidence interval; NAT neoadjuvant therapy. Cases with I2 > 50% are considered substantially heterogeneous
Fig. 4
Fig. 4
Effect of prehabilitation during NAT on the change of grip strength. Forest plot using only randomized controlled trials. Std. standard; 95% CI 95% confidence interval; NAT neoadjuvant therapy. Cases with I2 > 50% are considered substantially heterogeneous
Fig. 5
Fig. 5
Effect of prehabilitation during NAT on skeletal muscle mass. Forest plot shows effect on skeletal muscle mass after NAT. Forest plot using only randomized controlled trials. Std. standard; 95% CI 95% confidence interval; NAT neoadjuvant therapy. Cases with I2 > 50% are considered substantially heterogeneous
Fig. 6
Fig. 6
Effect of prehabilitation on tolerance to NAT. Forest plot shows effect on NAT completion. Forest plot using only randomized controlled trials. 95% CI 95% confidence interval; M-H Mantel–Haenszel; NAT neoadjuvant therapy. Cases with I2 > 50% are considered substantially heterogeneous
Fig. 7
Fig. 7
Effect of prehabilitation during NAT on postoperative complications. Forest plot using randomized controlled trial (RCT) and non-RCTs. 95% CI 95% confidence interval; M-H Mantel–Haenszel; NAT neoadjuvant therapy. Cases with I2 > 50% are considered substantially heterogeneous
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