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

被引:26
作者
Halliday, Laura J. [1 ]
Boshier, Piers R. [1 ]
Doganay, Emre [1 ]
Wynter-Blyth, Venetia [2 ]
Buckley, John P. [3 ]
Moorthy, Krishna [1 ]
机构
[1] Imperial Coll London, Dept Surg & Canc, London, England
[2] Imperial Coll Healthcare NHS Trust, St Marys Hosp, Oesophagogastr Canc Surg Unit, London, England
[3] Univ Chester, Univ Ctr Shrewsbury, Ctr Act Living, Shrewsbury, Salop, England
关键词
adiposity; cancer; preoperative exercise; sarcopenia; NEOADJUVANT CHEMOTHERAPY; PHYSICAL-ACTIVITY; SARCOPENIA; OBESITY; EXERCISE; OUTCOMES; IMPACT; COMPLICATIONS; PREVALENCE; PREDICTOR;
D O I
10.1093/dote/doac046
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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 (Delta SMI mean difference = -2.2 cm(2)/m(2), 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 (Delta 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.
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页数:10
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