Preoperative Physical Activity is Associated with Prognosis in Patients with Esophageal Cancer Undergoing Thoracoscopic-laparoscopic Esophagectomy After Neoadjuvant Chemotherapy

Overview

Journal Gen Thorac Cardiovasc Surg

Specialties Cardiology & Vascular Diseases
General Surgery
Pulmonary Medicine

Date 2023 Sep 27

PMID 37759069

Authors

Takuya Fukushima

Noriko Watanabe

Yusuke Okita

Shota Yokota

Daisuke Kurita

Koshiro Ishiyama

Junya Oguma

Akira Kawai

Hiroyuki Daiko

Affiliations

Soon will be listed here.

Abstract

Objective: This study examined the association between a single preoperative physiotherapy session during neoadjuvant chemotherapy and physical function and that between preoperative physical activity and prognosis.

Methods: In this retrospective, single-center, observational study, we evaluated data from 234 patients scheduled for neoadjuvant chemotherapy and thoracoscopic-laparoscopic esophagectomy who underwent a single preoperative physiotherapy session. The five-repetition sit-to-stand test was performed before and after neoadjuvant chemotherapy. After neoadjuvant chemotherapy, patients were classified into high- and low-physical activity groups based on preoperative physical activity. To examine the association between preoperative physiotherapy and changes in physical function, a multivariate regression analysis was performed. The Cox proportional hazards model was used to investigate the association between preoperative physical activity and overall survival.

Results: The median percentage change in the five-repetition sit-to-stand test score was - 3.36%. In the multivariate regression analysis, the regression coefficient of the constant term was - 23.93 (95% confidence interval - 45.31 to - 2.56; P = 0.028). Low physical activity was significantly associated with overall survival after adjustment for confounding factors (P = 0.040).

Conclusions: This study demonstrated that a single preoperative physiotherapy session during neoadjuvant chemotherapy improves physical function, and preoperative physical activity is significantly associated with prognosis.

References

Law S, Wong J . What is appropriate treatment for carcinoma of the thoracic esophagus?. World J Surg. 2001; 25(2):189-95. DOI: 10.1007/s002680020018. View

Takeuchi H, Miyata H, Gotoh M, Kitagawa Y, Baba H, Kimura W . A risk model for esophagectomy using data of 5354 patients included in a Japanese nationwide web-based database. Ann Surg. 2014; 260(2):259-66. DOI: 10.1097/SLA.0000000000000644. View

Fujishima S, Tsujimoto H, Nagata K, Sugasawa H, Nomura S, Ito N . Postoperative pneumonia causes the loss of skeletal muscle volume and poor prognosis in patients undergoing esophagectomy for esophageal cancer. Gen Thorac Cardiovasc Surg. 2020; 69(1):84-90. DOI: 10.1007/s11748-020-01482-4. View

Fukushima T, Watanabe N, Okita Y, Yokota S, Matsuoka A, Kojima K . The evaluation of the association between preoperative sarcopenia and postoperative pneumonia and factors for preoperative sarcopenia in patients undergoing thoracoscopic-laparoscopic esophagectomy for esophageal cancer. Surg Today. 2023; 53(7):782-790. DOI: 10.1007/s00595-022-02620-6. View

Wang P, Xu L, Chen X, Xu L, Yu Y, Zhang R . Sarcopenia and Short-Term Outcomes After Esophagectomy: A Meta-analysis. Ann Surg Oncol. 2020; 27(8):3041-3051. DOI: 10.1245/s10434-020-08236-9. View

Fujihata S, Ogawa R, Nakaya S, Hayakawa S, Okubo T, Sagawa H . The impact of skeletal muscle wasting during neoadjuvant chemotherapy on postoperative anastomotic leakage in patients with esophageal cancer. Esophagus. 2020; 18(2):258-266. DOI: 10.1007/s10388-020-00774-1. View

Reisinger K, Bosmans J, Uittenbogaart M, Alsoumali A, Poeze M, Sosef M . Loss of Skeletal Muscle Mass During Neoadjuvant Chemoradiotherapy Predicts Postoperative Mortality in Esophageal Cancer Surgery. Ann Surg Oncol. 2015; 22(13):4445-52. PMC: 4644199. DOI: 10.1245/s10434-015-4558-4. View

Tukanova K, Chidambaram S, Guidozzi N, Hanna G, McGregor A, Markar S . Physiotherapy Regimens in Esophagectomy and Gastrectomy: a Systematic Review and Meta-Analysis. Ann Surg Oncol. 2021; 29(5):3148-3167. PMC: 8990957. DOI: 10.1245/s10434-021-11122-7. View

Christensen J, Simonsen C, Banck-Petersen A, Thorsen-Streit S, Herrstedt A, Djurhuus S . Safety and feasibility of preoperative exercise training during neoadjuvant treatment before surgery for adenocarcinoma of the gastro-oesophageal junction. BJS Open. 2019; 3(1):74-84. PMC: 6354184. DOI: 10.1002/bjs5.50110. View

10.

Halliday L, Doganay E, Wynter-Blyth V, Hanna G, Moorthy K . The Impact of Prehabilitation on Post-operative Outcomes in Oesophageal Cancer Surgery: a Propensity Score Matched Comparison. J Gastrointest Surg. 2020; 25(11):2733-2741. PMC: 8602132. DOI: 10.1007/s11605-020-04881-3. View

11.

Low D, Allum W, De Manzoni G, Ferri L, Immanuel A, Kuppusamy M . Guidelines for Perioperative Care in Esophagectomy: Enhanced Recovery After Surgery (ERAS) Society Recommendations. World J Surg. 2018; 43(2):299-330. DOI: 10.1007/s00268-018-4786-4. View

12.

Boden I, Skinner E, Browning L, Reeve J, Anderson L, Hill C . Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. BMJ. 2018; 360:j5916. PMC: 5782401. DOI: 10.1136/bmj.j5916. View

13.

Inoue J, Ono R, Makiura D, Kashiwa-Motoyama M, Miura Y, Usami M . Prevention of postoperative pulmonary complications through intensive preoperative respiratory rehabilitation in patients with esophageal cancer. Dis Esophagus. 2012; 26(1):68-74. DOI: 10.1111/j.1442-2050.2012.01336.x. View

14.

Zhong J, Zhang S, Li C, Hu Y, Wei W, Liu L . Active cycle of breathing technique may reduce pulmonary complications after esophagectomy: A randomized clinical trial. Thorac Cancer. 2021; 13(1):76-83. PMC: 8720618. DOI: 10.1111/1759-7714.14227. View

15.

Patel A, Friedenreich C, Moore S, Hayes S, Silver J, Campbell K . American College of Sports Medicine Roundtable Report on Physical Activity, Sedentary Behavior, and Cancer Prevention and Control. Med Sci Sports Exerc. 2019; 51(11):2391-2402. PMC: 6814265. DOI: 10.1249/MSS.0000000000002117. View

16.

Shaker R, Kern M, Bardan E, Taylor A, STEWART E, Hoffmann R . Augmentation of deglutitive upper esophageal sphincter opening in the elderly by exercise. Am J Physiol. 1997; 272(6 Pt 1):G1518-22. DOI: 10.1152/ajpgi.1997.272.6.G1518. View

17.

Namiki C, Hara K, Tohara H, Kobayashi K, Chantaramanee A, Nakagawa K . Tongue-pressure resistance training improves tongue and suprahyoid muscle functions simultaneously. Clin Interv Aging. 2019; 14:601-608. PMC: 6432900. DOI: 10.2147/CIA.S194808. View

18.

Ramsey K, Rojer A, DAndrea L, Otten R, Heymans M, Trappenburg M . The association of objectively measured physical activity and sedentary behavior with skeletal muscle strength and muscle power in older adults: A systematic review and meta-analysis. Ageing Res Rev. 2021; 67:101266. DOI: 10.1016/j.arr.2021.101266. View

19.

Klukowska A, Staartjes V, Vandertop W, Schroder M . Five-Repetition Sit-to-Stand Test Performance in Healthy Individuals: Reference Values and Predictors From 2 Prospective Cohorts. Neurospine. 2022; 18(4):760-769. PMC: 8752709. DOI: 10.14245/ns.2142750.375. View

20.

Kobayashi K, Kanetaka K, Yoneda A, Kobayashi S, Maruya Y, Isagawa Y . Downstaging and Histological Effects Might Be Reliable Predictors of the Efficacy of DOC+CDDP+5-FU (DCF) as Neoadjuvant Therapy for Stage III or Borderline Resectable Esophageal Cancer: a Single Institute Experience. J Gastrointest Cancer. 2020; 52(2):582-592. DOI: 10.1007/s12029-020-00431-x. View