The association of preoperative nutritional status and physical fitness with postoperative outcomes in esophageal cancer: results from the PRIOR study

PURPOSE: To investigate whether preoperative nutritional status and physical fitness after prehabilitation are associated with surgical outcomes, functional capacity, fatigue, and quality of life after esophagectomy.

METHODS: This multicenter, observational cohort study included patients with esophageal cancer who underwent curative treatment and multimodal prehabilitation as part of standard care. Preoperative assessments included body mass index (BMI), risk of malnutrition, exercise capacity, hand grip strength, upper leg muscle function, physical activity level, and fatigue, after finishing prehabilitation. Differences in preoperative parameters between patients with and without postoperative overall or pulmonary complications were analyzed using independent T-tests. Associations with length of hospital stay, postoperative functional capacity, fatigue, and quality of life were examined using multivariable linear regression models.

RESULTS: Hundred sixty-eight patients were included, mean age 65.9±8.6 years; 78.0% male. Higher preoperative BMI was associated with more overall complications (p=.029). Better preoperative exercise capacity, and upper leg muscle function were associated with less pulmonary complications (p<.045), and better postoperative functional capacity (p<.032). Less preoperative fatigue was associated with better postoperative functional capacity, quality of life, and less fatigue (p≤.001). Risk of malnutrition, hand grip strength and physical activity level were not significantly associated with postoperative outcomes.

CONCLUSION: BMI, exercise capacity, upper leg muscle function, and fatigue seem to be important factors in the preoperative assessment before esophagectomy, both in terms of postoperative complications, postoperative functional capacity, fatigue, and quality of life. During (p)rehabilitation, specific attention is therefore needed for patients with a high BMI, low fitness level and high fatigue.