The course of physical fitness and nutritional status in patients following prehabilitation before esophageal cancer surgery: Results from the PRIOR study

Elja A E Reijneveld; Cezanne D Kooij; Jaap J Dronkers; B Feike Kingma; Joyce M A Stel; Miron Sauer; Richard van Hillegersberg; Peter van Duijvendijk; Sandra Beijer; Jelle P Ruurda; Cindy Veenhof; ‘PRIOR study group’

doi:10.1016/j.ejso.2025.109575

The course of physical fitness and nutritional status in patients following prehabilitation before esophageal cancer surgery: Results from the PRIOR study

Eur J Surg Oncol. 2025 Jan 3;51(3):109575. doi: 10.1016/j.ejso.2025.109575. Online ahead of print.

Collaborators

‘PRIOR study group’:
Ad Kerst¹², Elles Steenhagen¹², Femke van Leeuwen¹², Jan Willem Haveman¹³, Dolf Liest¹³, Stefan Bos¹³, Bea Sijtema¹³, Ewout Kouwenhoven¹⁴, Iris Mekenkamp¹⁴, Margreet Tinselboer¹⁴, Corine van Dijk¹⁴, Joran Kauw¹⁵, Mirjam Buitenhuis¹⁵, Willeke Frank¹⁵, Anthoinet Freriksen¹⁵, Tamara Warmelink¹⁶, Norma Schokker¹⁶, Miranda Velthuis¹⁷, Edwin van Adrichem¹⁸

Affiliations

¹ Research Center for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands. Electronic address: [email protected].
² Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands. Electronic address: [email protected].
³ Research Center for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands. Electronic address: [email protected].
⁴ Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands. Electronic address: [email protected].
⁵ Department of Rehabilitation Medicine, University Medical Center Groningen, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands. Electronic address: [email protected].
⁶ Department of Dietetics, ZGT Hospitals, Zilvermeeuw 1, 7609, PP, Almelo, the Netherlands. Electronic address: [email protected].
⁷ Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands. Electronic address: [email protected].
⁸ Department of Surgery, Gelre Hospital Apeldoorn, Albert Schweitzerlaan 31, 7334, DZ, Apeldoorn, the Netherlands. Electronic address: [email protected].
⁹ Netherlands Comprehensive Cancer Organisation (IKNL), Rijnkade 5, 3511, LC, Utrecht, the Netherlands. Electronic address: [email protected].
¹⁰ Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands. Electronic address: [email protected].
¹¹ Research Center for Healthy and Sustainable Living, Research Group Innovation of Movement Care, HU University of Applied Sciences Utrecht, Heidelberglaan 7, 3584, CS, Utrecht, the Netherlands; Department of Rehabilitation, Physiotherapy Science and Sport, Brain Center, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, the Netherlands. Electronic address: [email protected].
¹² University Medical Center Utrecht, the Netherlands.
¹³ University Medical Center Groningen, the Netherlands.
¹⁴ Hospital Group Twente, the Netherlands.
¹⁵ Gelre Hospital, the Netherlands.
¹⁶ Isala Hospital, the Netherlands.
¹⁷ Netherlands Comprehensive Cancer Organization, the Netherlands.
¹⁸ Hanze University of Applied Sciences, the Netherlands.

PMID: 39813770
DOI: 10.1016/j.ejso.2025.109575

Abstract

Introduction: This study evaluates the course of physical fitness and nutritional status during curative therapy for esophageal cancer, after implementation of a prehabilitation program. Additionally, the impact of baseline physical fitness level and severe postoperative complications on the course of individual patients were explored.

Materials and methods: This multicenter, observational cohort study included patients with esophageal cancer following curative treatment. Prehabilitation, consisting of supervised exercise training and nutritional counseling was offered as standard care to patients after neoadjuvant therapy, prior to surgery. Primary outcome measures included change of exercise capacity, hand grip strength, self-reported physical functioning, Body Mass Index, and malnutrition risk from diagnosis to 2-6 months postoperatively. Analyses over time were performed using linear mixed models, and linear mixed regression models to investigate the impact of baseline level and severe postoperative complications.

Results: Hundred sixty-eight patients were included (mean age 65.9 ± 8.6 years; 78.0 % male). All parameters (except for malnutrition risk) showed a decline during neoadjuvant therapy (p < .05), an improvement during prehabilitation (p < .005) and a decline postoperatively (p < .001), with a high heterogeneity between patients. Change in the outcomes from baseline to postoperatively was not different for patients with or without a severe complication. Better baseline physical fitness and nutritional status were significantly associated with a greater decline postoperatively (p < .001).

Conclusion: This study demonstrates a notable decline during neoadjuvant therapy, that fully recovers during prehabilitation, and a subsequent long lasting decline postoperatively. The heterogeneity in the course of physical fitness and nutritional status underlines the importance of individualized monitoring.

Keywords: Esophageal cancer; Nutritional status; Physical fitness; Prehabilitation.