The effect of a prehabilitation program on cardiorespiratory capacity following neoadjuvant treatment prior to surgery for locally advanced esophagogastric cancer

Neoadjuvant therapy (NAT) carries the risk of toxicity and reduces exercise capacity in patients having surgery for digestive cancer.. Our aim was to evaluate the effect of a 5-week structured exercise-training program (SETP) to improve physical fitness after NAT for locally advanced esophageal and gastric cancer. We also assessed the feasibility and safety of the program. Prospective observational cohort study of consecutive patients with locally advanced esophageal and gastric cancer scheduled for NAT. All patients underwent a CPET before, immediately after NAT, and after 5 weeks of a SETP, before surgery. Patients exercised in a supervised hospital setting, 5 times per week for 5 weeks (25 sessions). Nineteen patients were recruited but 2 were excluded due to complications of the primary tumor during the NAT. The final analysis includes 17 patients (13 men / 4 women) with a mean age of 66 years (range 40-80). Thirteen patients had esophageal / GEJ cancer and 4 had gastric cancer. 68% of patients received chemoradiotherapy (CROSS regime) and 32% chemotherapy (MAGIC scheme). All 17 patients completed at least 80% of the SETP, with an average of 23 sessions. All patients showed deterioration in values of CPET after neoadjuvant therapy, with significant improvement of them after the SETP (Figure 1) In Conclusion, 5-week exercise training program after neoadjuvant treatment improves cardiorespiratory fitness in patients with locally advanced esophagogastric cancer. This benefit may have an impact on the surgical outcome in this group of patients.