Multi-modal Prehabilitation and Outcomes after Gastroesophageal Cancer Surgery: A Cohort Study of Pulmonary Complications and Resilience to Major Postoperative Events

BACKGROUND: Esophago-gastric cancer surgery frequently results in substantial morbidity. Prehabilitation, an approach to optimize an individual's preoperative physical, nutritional, and mental health, may decrease postoperative complications. Here, we present perioperative and allied health findings from a multimodal prehabilitation study (ACTRN12623000183684). METHODS: This single-center observational study recruited patients with esophago-gastric cancer undergoing curative-intent treatment between 2017 and 2024. Patients who did and did not receive multimodal prehabilitation were compared. Prehabilitation involved personalized medical, physical, nutritional, and psychological optimization before surgery. The primary endpoint was the rate of postoperative respiratory complications. Secondary endpoints included other postoperative complications and allied health outcomes. RESULTS: In total, 164 participants (control n=121, prehabilitation n=43) underwent esophago-gastric cancer resection. More minimally invasive surgeries were performed in the prehabilitation group, but the baseline characteristics were otherwise similar between groups. Prehabilitation improved physical fitness and decreased malnutrition rates. Importantly, prehabilitation resulted in fewer postoperative 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 than in the control group. Moreover, prehabilitation was associated with diminished intensive care unit stays (median [IQR] 1 day [1.0-6.5] vs 1 day [1.0-3.0]; p=0.005) and hospital stays (14 days [9-24] vs 11 days [8-16]; p<0.001) and higher rates of adjuvant chemotherapy usage (51.0% vs 80.6%, p=0.004). Multivariate and sensitivity analyses demonstrated that prehabilitation, rather than surgical technique (laparoscopic vs open surgery), was independently associated with perioperative outcomes. CONCLUSION: This study demonstrates that multimodal prehabilitation improves perioperative outcomes for patients with esophago-gastric cancer, thus supporting routine integration of prehabilitation into perioperative care pathways.