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The effects of prehabilitation on body composition in patients undergoing multimodal therapy for esophageal cancer

Halliday, LJ; Boshier, PR; Doganay, E; Wynter-Blyth, V; Buckley, J; Moorthy, K

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Authors

LJ Halliday

PR Boshier

E Doganay

V Wynter-Blyth

K Moorthy



Abstract

Prehabilitation aims to optimize a patient's functional capacity in preparation for surgery. Esophageal cancer patients have a high incidence of sarcopenia and commonly undergo neoadjuvant therapy, which is associated with loss of muscle mass. This study examines the effects of prehabilitation on body composition during neoadjuvant therapy in esophageal cancer patients. In this cohort study, changes in body composition were compared between esophageal cancer patients who participated in prehabilitation during neoadjuvant therapy and controls who did not receive prehabilitation. Assessment of body composition was performed from CT images acquired at the time of diagnosis and after neoadjuvant therapy. Fifty-one prehabilitation patients and 28 control patients were identified. There was a significantly greater fall in skeletal muscle index (SMI) in the control group compared with the prehabilitation patients (? SMI mean difference = -2.2 cm2/m2, 95% CI -4.3 to -0.1, p=0.038). Within the prehabilitation cohort, there was a smaller decline in SMI in patients with =75% adherence to exercise in comparison to those with lower adherence (? SMI mean difference = -3.2, 95% CI -6.0 to -0.5, P =?0.023). A greater decrease in visceral adipose tissue (VAT) was seen with increasing volumes of exercise completed during prehabilitation (P =?0.046). Loss of VAT during neoadjuvant therapy was associated with a lower risk of post-operative complications (P =?0.017). By limiting the fall in SMI and promoting VAT loss, prehabilitation may have multiple beneficial effects in patients with esophageal cancer. Multi-center, randomized studies are needed to further explore these findings.

Citation

Halliday, L., Boshier, P., Doganay, E., Wynter-Blyth, V., Buckley, J., & Moorthy, K. (2022). The effects of prehabilitation on body composition in patients undergoing multimodal therapy for esophageal cancer. Diseases of the Esophagus, https://doi.org/10.1093/dote/doac046

Acceptance Date Jun 13, 2022
Publication Date Jul 7, 2022
Publicly Available Date May 30, 2023
Journal Diseases of the Esophagus
Print ISSN 1120-8694
Publisher Oxford University Press
DOI https://doi.org/10.1093/dote/doac046
Public URL https://keele-repository.worktribe.com/output/424997
Publisher URL https://academic.oup.com/dote/advance-article/doi/10.1093/dote/doac046/6632930

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Licence
https://creativecommons.org/licenses/by/4.0/

Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/

Copyright Statement
The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/ licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.






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