Prehabilitation in the age of multimodal therapy for esophageal cancer

Background: The 5-year survival rate for locally advanced esophageal cancer remains comparatively low, at 10-15%, despite advances in multimodal therapy and surgical techniques. For locally advanced but still resectable tumors, transthoracic esophagectomy with thoracic and abdominal lymphadenectomy is the current standard of care and is associated with a high postoperative morbidity rate of up to 60%. The need to optimize treatment with the aim of reducing postoperative morbidity and improving long-term survival is undisputed. Previous approaches have focused on advancing surgical techniques towards minimally invasive approaches and improving postoperative treatment. However, the optimal time to improve the patient's clinical condition is in the preoperative phase, as there is a valuable window of opportunity provided by prehabilitation (originally: pre-rehabilitation; improvement of the clinical condition before surgery). Objective: The aim of this review article is to provide a summarizing overview of the current study situation on prehabilitation in the field of abdominal surgery and to classify prehabilitation in the context of the multimodal treatment of locally advanced esophageal cancer. Materials and methods: This paper is based on a selective literature search in the PubMed database using the search terms "prehabilitation," "surgery," "abdominal surgery," and "preoperative exercise." Conclusion: Similar to rehabilitation, prehabilitation comprises a multimodal concept for the preoperative optimization of nutrition as well as the development of strength, mobility, endurance, and a psycho-oncological connection, with the aim of creating resources to promote a rapid recovery after surgery/therapy. However, prehabilitation programs vary in the way they are implemented, particularly in terms of duration, intensity, location (hospital/home), and supervision. Integration of prehabilitation into the therapeutic concept represents an improvement in the clinical condition of oncology patients before surgery or during neoadjuvant therapy. Modern oncology centers should monitor future evidence regarding prehabilitation and incorporate the meaningful effect of this preventive intervention into innovative, multimodal oncology therapy.