Prehabilitation of Patients With Oesophageal Malignancy Undergoing Peri‐Operative Treatment (Pre‐EMPT): Outcomes From a Prospective Controlled Trial

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.