Effect of exercise rehabilitation during neoadjuvant chemotherapy before esophageal cancer surgery on perioperative outcomes: A systematic review and meta-analysis

BACKGROUND: Exercise rehabilitation during neoadjuvant chemotherapy (NAT) prior to esophageal cancer (EC) surgery has the potential to improve patients' physical function and accelerate postoperative recovery, but its effect remains unclear. METHODS: A systematic review and meta-analysis were conducted to compare the clinical outcomes of exercise rehabilitation and usual care during preoperative NAT in patients with EC. Relevant literature in online databases EMBASE, PubMed, Web of Science, and ScienceDirect were thoroughly searched and then screened. The data related to clinical outcomes were extracted and synthesized by meta-analysis. RESULTS: A total of 10 studies involving 466 participants were included. Meta-analysis revealed significantly higher tumor response rates in the intervention group (risk difference = 0.28, 95% confidence interval [CI] = 0.12-0.44, P < .001), but no significant difference in T-stage downgrading rates between groups (risk difference = 0.11, 95% CI = -0.04 to 0.25, P = .138). The 6-minute walk distance was significantly greater in the intervention group (mean difference [MD] = 26.60 m, 95% CI = 6.61-46.58, P = .009), as was the daily step count (MD = 434.18 steps, 95% CI = 47.79-820.57, P = .028), and the peak oxygen uptake (MD = 2.55 mL/kg/min, 95% CI = 0.72-4.37, P = .023). No difference was found in maximal inspiratory pressure between groups (MD = 4.93, 95% CI = -3.09 to 12.96, P = .651). CONCLUSION: Exercise rehabilitation during NAT for EC may confer multidimensional benefits to patients' physical function. However, the current evidence level remains low due to the limited number and small sample sizes of the included studies.