Poster Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2023

Prehabilitation reduces postoperative surgical complications following oesophago-gastric cancer surgery (#187)

Kate Crombie 1 2 , Stephen Kunz 3 , Liam Johnson 1 4 , Jamiee Caic 5 , Brooke Chapman 5 , Ronald Ma 6 , Carlene Wilson 2 , Grace Williams 2 , Laurence Weinberg 7 , Marissa Ferguson 7 , Celia Lanteri 8 , Danny Brazzale 8 , Amanda Dalyell 3 , Kat Hall 7 9 , Linda Watson 3 , Ahmad Aly 3 , Darren Wong 10 , David Liu 7 9 11 , Ashley Bigaran 2 9
  1. School of Behavioural Sciences, Australian Catholic University, Melbourne, Victoria, Australia
  2. Wellness and Supportive Care, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
  3. Upper Gastrointestinal Surgery Unit, Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Melbourne, Victoria, Australia
  4. School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
  5. Department of Nutrition and Dietetics, Austin Health, Melbourne, Victoria, Australia
  6. Health Information Systems , Austin Health, Melbourne, Victoria, Australia
  7. Division of Surgery, Anaesthesia, and Procedural Medicine, Austin Health, Melbourne, Victoria , Australia
  8. Department of Respiratory Medicine, Austin Health, Melbourne, Victoria, Australia
  9. Department of Surgery, Austin Precinct, The University of Melbourne, Melbourne , Victoria, Australia
  10. Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Victoria, Australia
  11. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia

Background: Complications following oesophago-gastric cancer surgery are a frequent occurrence. Baseline comorbidities and reduced cardiorespiratory fitness and physical function increase rates of postoperative complications. Oesophago-gastric cancer patients undergoing prehabilitation, including exercise training (EXT), experience improved cardiorespiratory fitness and physical functioning; however, whether EXT reduces complication rates is unknown. We investigated the effect of EXT on postoperative complication rates and other surgical and physical outcomes in adults preparing for oesophago-gastric cancer surgery.

Methods: A single-centre comparative retrospective and prospective study recruited patients with oesophago-gastric cancer with or without neoadjuvant chemotherapy/radiotherapy into an EXT program. Participants were compared against their baseline data and to a set of historical controls who did not undergo prehabilitation from 2016-2021 (HC, n=287). EXT was performed twice weekly for three months at moderate to vigorous exercise intensities. Postoperative surgical outcomes included respiratory and cardiac complication rates, days in ICU, textbook outcomes, postoperative length of stay, complication grade and 30-day hospital stay. Physical outcomes assessed at baseline and prior to surgery included cardiorespiratory fitness (peak oxygen uptake, six-minute walk test) and physical function measures (sit-to-stand, grip strength).

Results: Twenty-one participants completed prehabilitation (81% male, age 66.5+10.2 years). EXT reduced cardiac complication rates (HC 29% vs. EXT 5%, p=0.01), days in ICU (3.5+4.0 vs. 1.9+2.4 days, p<0.001) and improved textbook outcomes (19% vs. 43%, p=0.02), compared with HC. No differences in other surgical outcomes (all, p>0.05) were detected between EXT and HC. Compared with baseline, no differences were detected in physical outcomes; however, trivial to medium effects (Cohens d=0.02-0.58) were observed in favour of the EXT.

Conclusion: Preliminary data suggests that EXT reduces postoperative complications following oesophago-gastric cancer surgery compared to HC. However, further research is needed to explore the impact of prehabilitation on postoperative outcomes in larger sample sizes to confirm these initial findings.