The Impact of Prehabilitation on Patient Outcomes in Oesophagogastric Cancer Surgery: Combined Data from Four Prospective Clinical Trials Performed Across the UK and Ireland

Sowrav Barman; Beth Russell; Robert C. Walker; William Knight; Cara Baker; Mark Kelly; James Gossage; Janine Zylstra; Greg Whyte; James Pate; Jesper Lagergren; Mieke Van Hemelrijck; Mike Browning; Sophie Allen; Shaun R. Preston; Javed Sultan; Pritam Singh; Timothy Rockall; William B. Robb; Roisin Tully; Lisa Loughney; Jarlath Bolger; Jan Sorensen; Chris G. Collins; Paul A. Carroll; Claire M. Timon; Mayilone Arumugasamy; Thomas Murphy; Noel McCaffrey; Mike Grocott; Sandy Jack; Denny Z.H. Levett; Tim J. Underwood; Malcolm A. West; Andrew R. Davies

doi:10.3390/cancers17111836

The Impact of Prehabilitation on Patient Outcomes in Oesophagogastric Cancer Surgery: Combined Data from Four Prospective Clinical Trials Performed Across the UK and Ireland

Sowrav Barman^*
, Beth Russell
, Robert C. Walker
, William Knight
, Cara Baker
, Mark Kelly
, James Gossage
, Janine Zylstra
, Greg Whyte
, James Pate
, Jesper Lagergren
, Mieke Van Hemelrijck
, Mike Browning
, Sophie Allen
, Shaun R. Preston
, Javed Sultan
, Pritam Singh
, Timothy Rockall
, William B. Robb
, Roisin Tully

Lisa Loughney, Jarlath Bolger, Jan Sorensen, Chris G. Collins, Paul A. Carroll, Claire M. Timon, Mayilone Arumugasamy, Thomas Murphy, Noel McCaffrey, Mike Grocott, Sandy Jack, Denny Z.H. Levett, Tim J. Underwood, Malcolm A. West, Andrew R. Davies^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: Prehabilitation is increasingly being used in patients undergoing multimodality treatment for oesophagogastric cancer (OGC). Most studies to date have been small, single-centre trials. This collaborative study sought to assess the overall impact of prehabilitation on patient outcomes following OGC surgery. Methods: Data came from four prospective prehabilitation trials conducted in the UK or Ireland in patients undergoing multimodality treatment for OGC. The studies included three randomised and one non-randomised clinical trial, each comparing a prehabilitation intervention group to controls. The prehabilitation interventions included aerobic training delivered by exercise physiologists alongside dietetic input throughout the treatment pathway. The primary outcome was survival (all-cause and disease-specific mortality). Secondary outcomes were differences in complications, cardio-respiratory fitness (changes in VO_{2 peak} and anaerobic threshold (AT)), chemotherapy completion rates, hospital length of stay, changes in body mass index, tumour regression and complication rates of anastomotic leak and pneumonia. Cox and logistic regression analysis provided hazard ratios (HR) and odds ratios (OR), respectively, with 95% confidence intervals (CI), adjusted for confounders. Results: Among 165 patients included, 88 patients were in the prehabilitation group and 77 patients were in the control group. All-cause and disease-specific mortality were not improved by prehabilitation (HR 0.67 95% CI 0.21–2.12 and HR 0.82 95% CI 0.42–1.57, respectively). The prehabilitation group experienced fewer major complications (20% vs. 36%, p = 0.034; adjusted OR of 0.54; 95%CI 0.26–1.13). There was a mitigated decline in VO_2 peak following neo-adjuvant therapy (delta prehabilitation −1.07 mL/kg/min vs. control −2.74 mL/kg/min; p = 0.035) and chemotherapy completion rates were significantly higher following prehabilitation (90% vs. 73%; p = 0.016). Hospital length of stay (10 vs. 12 days, p = 0.402) and neoadjuvant chemotherapy response (Mandard 1–3 41% vs. 35%; p = 0.494) favoured prehabilitation, albeit not statistically significantly. Conclusion: Despite some limitations in terms of heterogeneity of study methodology, this study suggests a number of meaningful clinical benefits from prehabilitation before surgery for OGC patients. Current initiatives to agree on national standards for delivering prehabilitation and the results of ongoing trials will help to further refine this important intervention and expand the evidence base to support the widespread adoption and implementation of prehabilitation programs.

Original language	English
Article number	1836
Journal	Cancers
Volume	17
Issue number	11
Early online date	30 May 2025
DOIs	https://doi.org/10.3390/cancers17111836
Publication status	Published - 1 Jun 2025

Keywords

cardiorespiratory fitness
chemotherapy
oesophagogastric cancer
postoperative complications
prehabilitation

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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The Impact of Prehabilitation_BARMAN_Publishedonline30May2025_GOLD VoR (CC-BY)Final published version, 1.51 MBLicence: CC BY

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Barman, S., Russell, B., Walker, R. C., Knight, W., Baker, C., Kelly, M., Gossage, J., Zylstra, J., Whyte, G., Pate, J., Lagergren, J., Van Hemelrijck, M., Browning, M., Allen, S., Preston, S. R., Sultan, J., Singh, P., Rockall, T., Robb, W. B., ... Davies, A. R. (2025). The Impact of Prehabilitation on Patient Outcomes in Oesophagogastric Cancer Surgery: Combined Data from Four Prospective Clinical Trials Performed Across the UK and Ireland. Cancers, 17(11), Article 1836. https://doi.org/10.3390/cancers17111836

@article{1e222836ea7c4e798d35a7e6a0ab0873,

title = "The Impact of Prehabilitation on Patient Outcomes in Oesophagogastric Cancer Surgery: Combined Data from Four Prospective Clinical Trials Performed Across the UK and Ireland",

abstract = "Background: Prehabilitation is increasingly being used in patients undergoing multimodality treatment for oesophagogastric cancer (OGC). Most studies to date have been small, single-centre trials. This collaborative study sought to assess the overall impact of prehabilitation on patient outcomes following OGC surgery. Methods: Data came from four prospective prehabilitation trials conducted in the UK or Ireland in patients undergoing multimodality treatment for OGC. The studies included three randomised and one non-randomised clinical trial, each comparing a prehabilitation intervention group to controls. The prehabilitation interventions included aerobic training delivered by exercise physiologists alongside dietetic input throughout the treatment pathway. The primary outcome was survival (all-cause and disease-specific mortality). Secondary outcomes were differences in complications, cardio-respiratory fitness (changes in VO2 peak and anaerobic threshold (AT)), chemotherapy completion rates, hospital length of stay, changes in body mass index, tumour regression and complication rates of anastomotic leak and pneumonia. Cox and logistic regression analysis provided hazard ratios (HR) and odds ratios (OR), respectively, with 95\% confidence intervals (CI), adjusted for confounders. Results: Among 165 patients included, 88 patients were in the prehabilitation group and 77 patients were in the control group. All-cause and disease-specific mortality were not improved by prehabilitation (HR 0.67 95\% CI 0.21–2.12 and HR 0.82 95\% CI 0.42–1.57, respectively). The prehabilitation group experienced fewer major complications (20\% vs. 36\%, p = 0.034; adjusted OR of 0.54; 95\%CI 0.26–1.13). There was a mitigated decline in VO2 peak following neo-adjuvant therapy (delta prehabilitation −1.07 mL/kg/min vs. control −2.74 mL/kg/min; p = 0.035) and chemotherapy completion rates were significantly higher following prehabilitation (90\% vs. 73\%; p = 0.016). Hospital length of stay (10 vs. 12 days, p = 0.402) and neoadjuvant chemotherapy response (Mandard 1–3 41\% vs. 35\%; p = 0.494) favoured prehabilitation, albeit not statistically significantly. Conclusion: Despite some limitations in terms of heterogeneity of study methodology, this study suggests a number of meaningful clinical benefits from prehabilitation before surgery for OGC patients. Current initiatives to agree on national standards for delivering prehabilitation and the results of ongoing trials will help to further refine this important intervention and expand the evidence base to support the widespread adoption and implementation of prehabilitation programs.",

keywords = "cardiorespiratory fitness, chemotherapy, oesophagogastric cancer, postoperative complications, prehabilitation",

author = "Sowrav Barman and Beth Russell and Walker, \{Robert C.\} and William Knight and Cara Baker and Mark Kelly and James Gossage and Janine Zylstra and Greg Whyte and James Pate and Jesper Lagergren and \{Van Hemelrijck\}, Mieke and Mike Browning and Sophie Allen and Preston, \{Shaun R.\} and Javed Sultan and Pritam Singh and Timothy Rockall and Robb, \{William B.\} and Roisin Tully and Lisa Loughney and Jarlath Bolger and Jan Sorensen and Collins, \{Chris G.\} and Carroll, \{Paul A.\} and Timon, \{Claire M.\} and Mayilone Arumugasamy and Thomas Murphy and Noel McCaffrey and Mike Grocott and Sandy Jack and Levett, \{Denny Z.H.\} and Underwood, \{Tim J.\} and West, \{Malcolm A.\} and Davies, \{Andrew R.\}",

note = "Publisher Copyright: {\textcopyright} 2025 by the authors.",

year = "2025",

month = jun,

day = "1",

doi = "10.3390/cancers17111836",

language = "English",

volume = "17",

journal = "Cancers",

issn = "2072-6694",

publisher = "Multidisciplinary Digital Publishing Institute (MDPI)",

number = "11",

}

Barman, S, Russell, B, Walker, RC, Knight, W, Baker, C, Kelly, M, Gossage, J, Zylstra, J, Whyte, G, Pate, J, Lagergren, J, Van Hemelrijck, M, Browning, M, Allen, S, Preston, SR, Sultan, J, Singh, P, Rockall, T, Robb, WB, Tully, R, Loughney, L, Bolger, J, Sorensen, J, Collins, CG, Carroll, PA, Timon, CM, Arumugasamy, M, Murphy, T, McCaffrey, N, Grocott, M, Jack, S, Levett, DZH, Underwood, TJ, West, MA & Davies, AR 2025, 'The Impact of Prehabilitation on Patient Outcomes in Oesophagogastric Cancer Surgery: Combined Data from Four Prospective Clinical Trials Performed Across the UK and Ireland', Cancers, vol. 17, no. 11, 1836. https://doi.org/10.3390/cancers17111836

TY - JOUR

T1 - The Impact of Prehabilitation on Patient Outcomes in Oesophagogastric Cancer Surgery

T2 - Combined Data from Four Prospective Clinical Trials Performed Across the UK and Ireland

AU - Barman, Sowrav

AU - Russell, Beth

AU - Walker, Robert C.

AU - Knight, William

AU - Baker, Cara

AU - Kelly, Mark

AU - Gossage, James

AU - Zylstra, Janine

AU - Whyte, Greg

AU - Pate, James

AU - Lagergren, Jesper

AU - Van Hemelrijck, Mieke

AU - Browning, Mike

AU - Allen, Sophie

AU - Preston, Shaun R.

AU - Sultan, Javed

AU - Singh, Pritam

AU - Rockall, Timothy

AU - Robb, William B.

AU - Tully, Roisin

AU - Loughney, Lisa

AU - Bolger, Jarlath

AU - Sorensen, Jan

AU - Collins, Chris G.

AU - Carroll, Paul A.

AU - Timon, Claire M.

AU - Arumugasamy, Mayilone

AU - Murphy, Thomas

AU - McCaffrey, Noel

AU - Grocott, Mike

AU - Jack, Sandy

AU - Levett, Denny Z.H.

AU - Underwood, Tim J.

AU - West, Malcolm A.

AU - Davies, Andrew R.

PY - 2025/6/1

Y1 - 2025/6/1

N2 - Background: Prehabilitation is increasingly being used in patients undergoing multimodality treatment for oesophagogastric cancer (OGC). Most studies to date have been small, single-centre trials. This collaborative study sought to assess the overall impact of prehabilitation on patient outcomes following OGC surgery. Methods: Data came from four prospective prehabilitation trials conducted in the UK or Ireland in patients undergoing multimodality treatment for OGC. The studies included three randomised and one non-randomised clinical trial, each comparing a prehabilitation intervention group to controls. The prehabilitation interventions included aerobic training delivered by exercise physiologists alongside dietetic input throughout the treatment pathway. The primary outcome was survival (all-cause and disease-specific mortality). Secondary outcomes were differences in complications, cardio-respiratory fitness (changes in VO2 peak and anaerobic threshold (AT)), chemotherapy completion rates, hospital length of stay, changes in body mass index, tumour regression and complication rates of anastomotic leak and pneumonia. Cox and logistic regression analysis provided hazard ratios (HR) and odds ratios (OR), respectively, with 95% confidence intervals (CI), adjusted for confounders. Results: Among 165 patients included, 88 patients were in the prehabilitation group and 77 patients were in the control group. All-cause and disease-specific mortality were not improved by prehabilitation (HR 0.67 95% CI 0.21–2.12 and HR 0.82 95% CI 0.42–1.57, respectively). The prehabilitation group experienced fewer major complications (20% vs. 36%, p = 0.034; adjusted OR of 0.54; 95%CI 0.26–1.13). There was a mitigated decline in VO2 peak following neo-adjuvant therapy (delta prehabilitation −1.07 mL/kg/min vs. control −2.74 mL/kg/min; p = 0.035) and chemotherapy completion rates were significantly higher following prehabilitation (90% vs. 73%; p = 0.016). Hospital length of stay (10 vs. 12 days, p = 0.402) and neoadjuvant chemotherapy response (Mandard 1–3 41% vs. 35%; p = 0.494) favoured prehabilitation, albeit not statistically significantly. Conclusion: Despite some limitations in terms of heterogeneity of study methodology, this study suggests a number of meaningful clinical benefits from prehabilitation before surgery for OGC patients. Current initiatives to agree on national standards for delivering prehabilitation and the results of ongoing trials will help to further refine this important intervention and expand the evidence base to support the widespread adoption and implementation of prehabilitation programs.

AB - Background: Prehabilitation is increasingly being used in patients undergoing multimodality treatment for oesophagogastric cancer (OGC). Most studies to date have been small, single-centre trials. This collaborative study sought to assess the overall impact of prehabilitation on patient outcomes following OGC surgery. Methods: Data came from four prospective prehabilitation trials conducted in the UK or Ireland in patients undergoing multimodality treatment for OGC. The studies included three randomised and one non-randomised clinical trial, each comparing a prehabilitation intervention group to controls. The prehabilitation interventions included aerobic training delivered by exercise physiologists alongside dietetic input throughout the treatment pathway. The primary outcome was survival (all-cause and disease-specific mortality). Secondary outcomes were differences in complications, cardio-respiratory fitness (changes in VO2 peak and anaerobic threshold (AT)), chemotherapy completion rates, hospital length of stay, changes in body mass index, tumour regression and complication rates of anastomotic leak and pneumonia. Cox and logistic regression analysis provided hazard ratios (HR) and odds ratios (OR), respectively, with 95% confidence intervals (CI), adjusted for confounders. Results: Among 165 patients included, 88 patients were in the prehabilitation group and 77 patients were in the control group. All-cause and disease-specific mortality were not improved by prehabilitation (HR 0.67 95% CI 0.21–2.12 and HR 0.82 95% CI 0.42–1.57, respectively). The prehabilitation group experienced fewer major complications (20% vs. 36%, p = 0.034; adjusted OR of 0.54; 95%CI 0.26–1.13). There was a mitigated decline in VO2 peak following neo-adjuvant therapy (delta prehabilitation −1.07 mL/kg/min vs. control −2.74 mL/kg/min; p = 0.035) and chemotherapy completion rates were significantly higher following prehabilitation (90% vs. 73%; p = 0.016). Hospital length of stay (10 vs. 12 days, p = 0.402) and neoadjuvant chemotherapy response (Mandard 1–3 41% vs. 35%; p = 0.494) favoured prehabilitation, albeit not statistically significantly. Conclusion: Despite some limitations in terms of heterogeneity of study methodology, this study suggests a number of meaningful clinical benefits from prehabilitation before surgery for OGC patients. Current initiatives to agree on national standards for delivering prehabilitation and the results of ongoing trials will help to further refine this important intervention and expand the evidence base to support the widespread adoption and implementation of prehabilitation programs.

KW - cardiorespiratory fitness

KW - chemotherapy

KW - oesophagogastric cancer

KW - postoperative complications

KW - prehabilitation

UR - https://www.scopus.com/pages/publications/105007706650

U2 - 10.3390/cancers17111836

DO - 10.3390/cancers17111836

M3 - Article

AN - SCOPUS:105007706650

SN - 2072-6694

VL - 17

JO - Cancers

JF - Cancers

IS - 11

M1 - 1836

ER -

The Impact of Prehabilitation on Patient Outcomes in Oesophagogastric Cancer Surgery: Combined Data from Four Prospective Clinical Trials Performed Across the UK and Ireland

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Keywords

UN SDGs

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