Geriatric co-managed prehabilitation before esophagectomy in patients aged ≥ 65 years with esophageal cancer: a prospective feasibility study with matched historical controls

Abstract Purpose Older patients undergoing esophagectomy remain at high risk for perioperative morbidity. This study evaluated the feasibility, safety and adherence of a multimodal prehabilitation program integrated with geriatric co-management in patients aged ≥ 65 years scheduled for transthoracic esophagectomy and explored perioperative outcomes. Methods In this single-center prospective feasibility study, patients aged ≥ 65 years scheduled for transthoracic esophagectomy completed a 4-week home-based program of endurance, respiratory, resistance and balance training combined with comprehensive geriatric assessment and medication optimization. Feasibility outcomes were retention, adherence and data completeness. Perioperative outcomes were compared with a 2:1 matched historical control cohort using cluster-robust linear regression for continuous outcomes and Firth penalized logistic regression for binary outcomes. Results Twenty-six patients were enrolled; 22 completed the intervention and were matched to 42 control records. At the first check-in 61.5% reported complete and 84.6% complete or mostly complete adherence; documentation was missing for 69.2% at the second. Despite matching, controls had more favorable performance status ( p = 0.023) and comorbidity burden ( p = 0.014). Postoperative complications, anastomotic leakage, hospital mortality and length of stay did not differ significantly. Intensive care unit (ICU) readmission was lower after prehabilitation (4.5% vs. 26.2%; odds ratio 0.19, 95% confidence interval 0.02–0.90; p = 0.035), but not after adjustment for surgical approach (adjusted odds ratio 0.30; p = 0.172). Conclusion Multimodal prehabilitation with geriatric co-management was feasible and safe in this population. Overall postoperative morbidity was unchanged. The lower ICU readmission rate did not withstand adjustment and is hypothesis-generating requiring an adequately powered randomized trial. Future programs need more robust adherence monitoring. Trial registration ClinicalTrials.gov NCT05167682, registered 9 December 2021, retrospectively registered.