L. C. Dewberry1, L. J. Wingrove3, A. Glode4, S. Jain2, M. Boniface1, S. L. Davis3, S. Leong3, K. Goodman2, S. Tracey2, W. T. Purcell3, M. D. McCarter1 1University Of Colorado Denver,Department of Surgery,Aurora, CO, USA 2University Of Colorado Denver,Department Of Radiation Oncology,Aurora, CO, USA 3University Of Colorado Denver,Division Of Medical Oncology,Aurora, CO, USA 4University Of Colorado Denver,Department Of Clinical Pharmacy,Aurora, CO, USA
Introduction:
Locally advanced esophageal cancer is a complex disease process often treated with neoadjuvant therapy followed by surgery. However, many patients experience a clinical deconditioning during neoadjuvant therapy. Prehabilitation programs in other areas of surgery have demonstrated improved postoperative outcomes. The aim of this study is to evaluate the feasibility of a pilot prehabilitation program and determine preliminary effects on surgical and cancer related outcomes.
Methods:
A retrospective review of patients treated at a single institution with resectable esophageal cancer was performed. Patients voluntarily undergoing the prehabilitation program (n=11) were compared to an equal number of historic controls (standard). Patients in the prehabilitation group received a protocol structured support in several clinical domains including nutrition, intravenous fluids, medications, psychosocial support, and physical exercise. Preliminary outcomes evaluated included nutritional parameters, surgical complications, mortality, readmission rates, and pathological outcomes.
Results:
Clinical stage and comorbidities were well matched between groups. The structured prehabilitation program was feasible and well received by participants. Fewer patients required admission during neoadjuvant therapy in the prehabilitation group (27.3% versus 54.5%). Percentage weight loss was 3% in the prehabilitation group versus 4.3% in the control group. Compared to the control group, the prehabilitation group demonstrated 0.0% versus 18.2% 30-day postoperative readmission rate and 18.2% vs. 27.3% 90-day postoperative readmission rate. The prehabilitation group had a similar percentage of complete pathologic response (27.0% versus 18.0%). There were no statistically significant differences between groups in regards to complications or mortality.
Conclusion:
The pilot prehabilitation program demonstrated its feasibility. Although the small population limits evaluation of statistical significance, trends in the data suggest a potential benefit of the prehabilitation program on neoadjuvant hospital admission rates, post surgical readmission rates, nutritional status, and oncologic outcomes. Larger randomized studies are warranted to assess the program’s overall utility.