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Prehabilitation of patients with oesophageal malignancy undergoing peri-operative treatment (Pre-EMPT): outcomes from a prospective controlled trial
Bott, R. Zylstra, J. Knight, W. Whyte, G.P. Moss, C. Browning, M. Lagergren, J. Van Hemelrijck, M. Davies, A.R.
Bott, R.
Zylstra, J.
Knight, W.
Whyte, G.P.
Moss, C.
Browning, M.
Lagergren, J.
Van Hemelrijck, M.
Davies, A.R.
Editors
Other contributors
Epub Date
Issue Date
2025-01-29
Submitted date
Alternative
Abstract
Background: The Pre-EMPT study aimed to determine if structured exercise could reduce length of stay, post-operative complications and improve fitness and health-related quality of life (HQRL) in patients undergoing neoadjuvant chemotherapy (NAC) and oesophagectomy. Methods: A prospective non-randomised trial compared a standard care pathway (control) to a structured prehabilitation exercise programme (intervention) commenced before NAC and surgery for oesophageal adenocarcinoma. Length of hospital stay and post-operative complications were recorded. Cardiopulmonary exercise testing (CPEX), body composition analyses, lymphocyte levels and HRQL questionnaires were performed at multiple time points. Results: Median length of stay was similar in both groups. There were 6 versus 11 complications observed (intervention vs control p = 0.086). Cardio-pulmonary fitness (VO2peak) declined after NAC, but less in the intervention group (intervention −13.54% vs control −21.40%, p = 0.02). Body composition improved in the intervention group (FMi/FFMi −5.5% intervention, 10.7% control p = 0.043). Performance, cognitive, sleep and emotional function scores improved following NAC in the intervention group. Lymphocyte subsets increased in the intervention group compared to the control group after chemotherapy (p = 0.034). Chemotherapy response was improved in the intervention group (p = 0.022). Conclusion: A structured exercise programme may mitigate cardiopulmonary deconditioning, reduce sarcopenia and offset lymphopenia, during chemotherapy, in patients undergoing NAC and oesophagectomy.
Citation
Bott, R., Zylstra, J, Knight, W, Whyte, GP, Lane, AM, Moss, C, Browning, M, Lagergren, J, Van Hemelrijck, M, Davies, AR, the Pre-EMPT study group (2025) Prehabilitation of Patients With Oesophageal Malignancy Undergoing Peri-Operative Treatment (Pre-EMPT): Outcomes From a Prospective Controlled Trial. Journal of Surgical Oncology, 131, pp. 1508–1520.
Publisher
Journal
Research Unit
PubMed ID
39878357 (pubmed)
PubMed Central ID
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Type
Journal article
Language
en
Description
© 2025 The Authors, published by Wiley. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1002/jso.28079
Series/Report no.
ISSN
0022-4790
EISSN
1096-9098
ISBN
ISMN
Gov't Doc #
Sponsors
The Pre‐EMPT trial was funded by the Guy's and St Thomas' Charity(REC no. 16/SC/0438; ClinicalTrials. gov: NCT03626610).