PREHABILITATION INCLUDING PHYSICAL ACTIVITY AND INTEGRATED NUTRITIONAL-PSYCHOLOGICAL CARE IN THE PERIOPERATIVE MANAGEMENT OF ESOPHAGEAL CANCER
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5365Keywords:
Prehabilitation, Esophageal Cancer, Surgery, Nutrition, Physical ActivityAbstract
Context: The aim of this study is to demonstrate that prehabilitation encompassing nutritional assessment, optimization of nutritional support, structured exercise, and psychological intervention significantly influences patients’ recovery to their preoperative functional status. Moreover, in individuals presenting with poorer baseline condition, prehabilitation may contribute to functional improvement and reduce the risk of postoperative complications.
Methods: We conducted a review of the current literature on surgical prehabilitation for esophageal cancer, focusing on studies indexed in PubMed that examine preoperative interventions implemented prior to esophagectomy to improve patients’ preoperative condition and enhance postoperative recovery.
Results: Available evidence from the literature indicates a beneficial effect of prehabilitation on postoperative functional capacity and the rate of patients’ return to activities of daily living. At the same time, evidence regarding its impact on short- and long-term clinical outcomes remains limited, which underscores the need for further well-designed studies incorporating a broader range of variables.
Conclusions: The findings suggest that multimodal preoperative interventions, including physical activity, nutritional support, and anxiety reduction strategies, may serve as a valuable adjunct to enhanced recovery after surgery programs and facilitate a faster return of patients to basic activities of daily living.
References
Steenhagen, E., van Vulpen, J. K., van Hillegersberg, R., May, A. M., & Siersema, P. D. (2017). Nutrition in peri-operative esophageal cancer management. Expert Review of Gastroenterology & Hepatology, 11(7), 663–672.
Liu, C. Q., Ma, Y. L., Qin, Q., et al. (2023). Epidemiology of esophageal cancer in 2020 and projections to 2030 and 2040. Thoracic Cancer, 14(1), 3–11.
Casey, P., Gossage, J. A., Ford, K., et al. (2023). The current landscape of nutrition care in oesophageal and gastric cancer: Insights from the national oesophagogastric nutrition audit (NONA) survey. Clinical Nutrition ESPEN, 56, 87–93.
Davies, S. J., West, M. A., Rahman, S. A., Underwood, T. J., & Marino, L. V. (2021). Oesophageal cancer: The effect of early nutrition support on clinical outcomes. Clinical Nutrition ESPEN, 42, 117–123.
Gillis, C., Buhler, K., Bresee, L., et al. (2018). Effects of nutritional prehabilitation, with and without exercise, on outcomes of patients who undergo colorectal surgery: A systematic review and meta-analysis. Gastroenterology, 155(2), 391–410.e4.
Deftereos, I., Kiss, N., Isenring, E., Carter, V. M., & Yeung, J. M. (2020). A systematic review of the effect of preoperative nutrition support on nutritional status and treatment outcomes in upper gastrointestinal cancer resection. European Journal of Surgical Oncology, 46(8), 1423–1434.
Cao, Y., Han, D., Zhou, X., Han, Y., Zhang, Y., & Li, H. (2022). Effects of preoperative nutrition on postoperative outcomes in esophageal cancer: A systematic review and meta-analysis. Diseases of the Esophagus, 35(3), doab028.
Abouarab, A. G., Mohsen, A. H., Mosellhy, N. E., Mousa, M. I., Abbas, O., & Manea, H. (2025). Evaluating the impact of enteral nutrition vs parenteral nutrition on postoperative outcomes in esophageal cancer patients after esophagectomy: A systematic review and meta-analysis of randomized controlled trials. Cureus, 17(9), e92413.
Meza-Valderrama, D., Marco, E., Dávalos-Yerovi, V., et al. (2021). Sarcopenia, malnutrition, and cachexia: Adapting definitions and terminology of nutritional disorders in older people with cancer. Nutrients, 13(3), 761.
Cederholm, T., Barazzoni, R., Austin, P., et al. (2017). ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical Nutrition, 36(1), 49–64.
Kłęk, S., & Kapała, A. (2018). Nutritional treatment. Oncology in Clinical Practice, 14(4).
Zdankiewicz, A., Konaszczuk, W., Pawłowski, P., & Kościołek, A. (2023). Prehabilitation and nutritional interventions: An interdisciplinary perspective. Journal of Education, Health and Sport, 13(2), 116–123.
Peterson, S. J., & Mozer, M. (2017). Differentiating sarcopenia and cachexia among patients with cancer. Nutrition in Clinical Practice, 32(1), 30–39.
Jensen, G. L., & Cederholm, T. (2018). The malnutrition overlap syndromes of cachexia and sarcopenia: A malnutrition conundrum. American Journal of Clinical Nutrition, 108(6), 1157–1158.
Oguma, J., Ozawa, S., Ishiyama, K., & Daiko, H. (2022). Clinical significance of sarcopenic dysphagia for patients with esophageal cancer undergoing esophagectomy: A review. Annals of Gastroenterological Surgery, 6(6), 738–745.
Hussein, M., Mohamed, T., Mubarak, F. A., et al. (2025). Nutritional support and immunonutrition in esophageal cancer: From perioperative care to long-term survivorship. Biomolecules and Biomedicine.
Kitagawa, H., Namikawa, T., Yatabe, T., et al. (2017). Effects of a preoperative immune-modulating diet in patients with esophageal cancer: A prospective parallel group randomized study. Langenbeck’s Archives of Surgery, 402(3), 531–538.
Katada, C., Fukazawa, S., Sugawara, M., et al. (2021). Randomized study of prevention of gastrointestinal toxicities by nutritional support using an amino acid-rich elemental diet during chemotherapy in patients with esophageal cancer (KDOG 1101). Esophagus, 18(2), 296–305.
Reijneveld, E. A. E., Griekspoor, M., Dronkers, J. J., Kerst, A., Ruurda, J. P., & Veenhof, C. (2024). Identification of subgroups of patients with oesophageal cancer based on exercise intensity during prehabilitation. Disability and Rehabilitation, 46(26), 6431–6438.
An, K. R., Seijas, V., Xu, M. S., et al. (2024). Does prehabilitation before esophagectomy improve postoperative outcomes? A systematic review and meta-analysis. Diseases of the Esophagus, 37(3), doad066.
Halliday, L. J., Doganay, E., Wynter-Blyth, V. A., Hanna, G. B., & Moorthy, K. (2021). The impact of prehabilitation on post-operative outcomes in oesophageal cancer surgery: A propensity score matched comparison. Journal of Gastrointestinal Surgery, 25(11), 2733–2741.
Mizusawa, H., Higashimoto, Y., Shiraishi, O., et al. (2025). Preoperative inspiratory muscle training preserved diaphragmatic excursion after esophagectomy: A randomized-controlled trial. Esophagus, 22(3), 331–339.
Matsumura, K., Takami, A., Tajima, S., Sasaki, Y., Kato, N., & Makino, M. (2024). Effect of preoperative physical activity on postoperative outcomes in esophageal cancer. Journal of Physical Therapy Science, 36(9), 557–563.
Loughney, L., Murphy, K., Tully, R., et al. (2024). The effect of a pre- and post-operative exercise program versus standard care on physical activity and sedentary behavior of patients with esophageal and gastric cancer undergoing neoadjuvant treatment prior to surgery (PERIOP-OG trial): A randomized controlled trial. Diseases of the Esophagus, 37(10), doae044.
Kasai, F., Kobayashi, T., Hoshi, E., et al. (2024). Does prehabilitation reduce postoperative length of hospital stay after esophageal cancer surgery? Progress in Rehabilitation Medicine, 9, 20240013.
Wykypiel, H., Gehwolf, P., Kienzl-Wagner, K., et al. (2024). Clinical implementation of minimally invasive esophagectomy. BMC Surgery, 24(1), 337.
Bograd, A. J., & Molena, D. (2021). Minimally invasive esophagectomy. Current Problems in Surgery, 58(10), 100984.
Weijs, T. J., Berkelmans, G. H., Nieuwenhuijzen, G. A., et al. (2016). Immediate postoperative oral nutrition following esophagectomy: A multicenter clinical trial. Annals of Thoracic Surgery, 102(4), 1141–1148.
Okamoto, H., Sasaki, M., Johtatsu, T., et al. (2011). Resting energy expenditure and nutritional status in patients undergoing transthoracic esophagectomy for esophageal cancer. Journal of Clinical Biochemistry and Nutrition, 49(3), 169–173.
Paul, M., Baker, M., Williams, R. N., & Bowrey, D. J. (2017). Nutritional support and dietary interventions following esophagectomy: Challenges and solutions. Nutrition and Dietary Supplements, 9, 9–21.
Arends, J., Baracos, V., Bertz, H., et al. (2017). ESPEN expert group recommendations for action against cancer-related malnutrition. Clinical Nutrition, 36(5), 1187–1196.
Terayama, M., Imamura, Y., Kitazawa, T., et al. (2025). The effect of a low-carbohydrate enteral nutrition formula on postoperative hyperglycemia in non-diabetic patients with esophageal cancer: A randomized exploratory phase II trial (ENLICHE study). PLoS ONE, 20(5), e0325039.
Long, H., Yang, H., Lin, Y., Situ, D., & Liu, W. (2013). Fish oil-supplemented parenteral nutrition in patients following esophageal cancer surgery: Effect on inflammation and immune function. Nutrition and Cancer, 65(1), 71–75.
Doganay, E., & Moorthy, K. (2019). Prehabilitation for esophagectomy. Journal of Thoracic Disease, 11(Suppl. 5), S632–S638.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Gabriel Mandera, Dawid Sobański, Julia Raszewska, Wiktor Jabłoński, Adam Perek, Klaudia Kapelka, Julia Anna Świerczek, Weronika Targosz, Aleksandra Wesołowska, Karolina Pyrtek
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
How to Cite
