BACKGROUND
Oesophago-gastric cancer surgery commonly results in significant peri-operative morbidity. Prehabilitation, an approach to optimise patients’ pre-operative functional, nutritional and mental reserves, may reduce post-operative complications. We present findings from our multi-modal prehabilitation trial (SOCS). Trial registration: ACTRN12623000183684.
METHODS
A single centre, comparative retrospective and prospective trial was conducted recruiting patients with oesophago-gastric cancer undergoing curative-intent treatment from 2022-2024. This cohort was compared to patients who did not undergo prehabilitation (control) from 2017-2024. Prehabilitation involved personalised medical, physical, nutritional and psychological optimization prior to surgery. Primary endpoint is the rate of post-operative respiratory complications. Secondary outcomes include post-operative surgical and perioperative complications, cancer event-free as well as overall survival, healthcare utilisation rates, exercise and nutrition outcomes.
RESULTS
164 (Control n=121, Prehabilitation n=43) patients underwent oesophago-gastric cancer resection. Besides more minimally invasive surgeries being performed in the prehabilitation group, baseline characteristics were similar between the two groups. Prehabilitation improved physical fitness and decreased malnutrition rates based on validated assessments. Importantly, compared to controls, prehabilitation decreased post-operative respiratory (43.8% vs 20.9%, p=0.010), cardiac (22.3% vs 7.0%, p=0.037), hepatic (9.1% vs 0.0%, p=0.031) and renal (9.9% vs 0.0%, p=0.037) complications. This was associated with shorter ICU [median(IQR), 1(1-6.5) vs 1(1-3) days] and hospital [14(9-24) vs 11(8-16) days] length-of-stay, and increased rates of delivering adjuvant chemotherapy (51.0% vs 80.6%, p=0.004). Multivariate and sensitivity analyses demonstrated that prehabilitation and not surgical technique was independently associated with perioperative outcomes. Critically, cancer event-free (HR 0.46, 95%CI 0.26-0.81) and overall (HR 0.44, 95%CI 0.22-0.89) survival was superior in the prehabilitation group.
CONCLUSIONS
Our SOCS trial demonstrates that multi-modal prehabilitation improves perioperative and oncological outcomes for patients with oesophago-gastric cancer.